Preamble

The House met at half-past Two o'clock

PRAYERS

[MR. SPEAKER in the Chair]

PRIVATE BUSINESS

GREATER MANCHESTER (LIGHT RAPID TRANSIT SYSTEM) BILL [Lords] (By Order)

GREATER MANCHESTER (LIGHT RAPID TRANSIT SYSTEM) (No. 2) BILL [Lords] (By Order)

Orders for consideration, as amended, read.

To be considered upon Thursday 21 January.

Oral Answers to Questions — EDUCATION AND SCIENCE

Education Reform

Mr. Wallace: To ask the Secretary of State for Education and Science what recent representations he has received concerning clauses 82 to 113 of the Education Reform Bill, relating to further and higher education, as they affect Scotland.

The Parliamentary Under-Secretary of State for Education and Science (Mr. Robert Jackson): Of those mentioned, only clauses 92 and 94, which deal with the new Universities Funding Council, extend to Scotland. We have received a number of representations about these provisions, though none specifically on their effect in Scotland.

Mr. Wallace: I am sure that the Minister is well aware of the distinctive and historic traditions of Scottish universities, not least their diverse courses and four-year honours degree courses. What assurances can he give Scottish universities that the Scottish committee of the UFC will have scope and independence to allow that diversity and historic tradition to continue and that they will not be brought into the role of English universities?

Mr. Jackson: It is good to hear the hon. Gentleman marching towards the sound of gunfire with his colleagues. Let us hope that he does not end up as red meat.
The hon. Gentleman is well aware that the relationship between the Government and the universities is conducted on an arm's length principle through the University Grants Committee, and will be, in future, through the UFC. It will be for those institutions to determine their policy in the organisation of universities in Scotland, as it is throughout the rest of the country.

Mr. Bill Walker: Will my hon. Friend bear in mind that Scots do not take lightly the differences between our universities and those south of the border? We are proud

of the four-year courses that we run in Scotland. All the evidence shows that they have been beneficial to those who have undergone the courses. More important, we should like to retain the independence that has existed in the past.

Mr. Jackson: My hon. Friend is perfectly right about the value of Scottish universities. Indeed, three out of eight were rated above average by the UGC during recent research exercises. The Government recognise the special position of Scottish universities and their four-year courses by virtue of the fact that in Scotland one third more is spent per student than in England and Wales.

Mr. Ernie Ross: The Education Reform Bill will have an effect on Scotland. What guarantee can the Minister give with regard to the discussions involving Stirling, Dundee and St. Andrew's? If one of those parties fails to agree on proposals about sharing courses, what will be the effect of the clause on funding and the taking back of funds by the UFC, and will it apply in the new circumstances?

Mr. Jackson: The present position will continue after the Bill is enacted, assuming that it is. There will be an arm's length relationship between the Government and the universities. It is up to the UGC—in future, the UFC—to to organise provision, in agreement with the universities.

Mr. Andrew F. Bennett: Will the Minister explain why Scottish universities have done particularly badly under this Conservative Administration? Why have Scottish universities had a cut in resources of 20 per cent. between 1983 and 1987, while the rest of United Kingdom universities have had an average cut of 12 per cent.? Under the proposed legislation, how will he ensure that Scotland is adequately represented on the university body, and how will he get co-ordination between the UFC and central institutions to ensure that higher education right across Scotland is co-ordinated?

Mr. Jackson: The Government have agreed that there should be a Scottish committee of the UFC, and one of its tasks will be to consider co-ordination with the central institutions. I have always understood that the Labour party was a national party—or at least that it intended to continue to be so. We are pursuing a national policy, as did the Labour party when in government. The UGC applies national criteria evenly and fairly to all university institutions throughout the country.

Mrs. Margaret Ewing: How can the Minister reconcile the UGC's statement that universities should recruit 900 new members of staff per year when financial stringencies are forcing them to draw up plans for 2,500 redundancies? What is his response to Sir Alwyn Williams, the principal of Glasgow university, who last weekend spoke about the disinherited generations of the next two decades, the scholars and researchers who, under this Government, and I quote—

Mr. Speaker: Order. No quotations at Question Time.

Mrs. Ewing: Sir Alwyn Williams said that we were heading down the road to mediocrity.

Mr. Jackson: In the past two years the Government have increased expenditure on universities by 18 per cent. We have specifically responded to redundancies by providing £155 million to be spent on restructuring over the next three years.

Nursery Education

Mr. Steinberg: To ask the Secretary of State for Education and Science what plans he has to increase the level of nursery provision; and if he will make a statement.

The Parliamentary Under-Secretary of State for Education and Science (Mr. Bob Dunn): None. My right hon. Friend has very recently restated the Government's policy on the education of under-fives in his memorandum on the report of the Education, Science and Arts Committee in the previous Session, which the House will remember was entitled "Achievement in Primary Schools".

Mr. Steinberg: I am sure that the majority of hon. Members appreciate the importance of nursery provision to future education and social development. Is it not deplorable that only 23 per cent. of our children get nursery provision? Will the Minister explain what provision he intends to make, bearing in mind that in 1972 the Prime Minister promised that by 1982 there would be nursery provision for 90 per cent. of our children? Is it not deplorable also that the Government hide behind the record of Labour local authorities that provide nursery provision—[HON. MEMBERS: "Too long".]—Not long enough. The 10 best performers are Labour-controlled local authorities and the worst 10 are Tory-controlled.

Mr. Speaker: I ask for brief questions.

Mr. Dunn: I remind the hon. Gentleman that provision and demand in the nursery sector are discretionary. Nevertheless, most education authorities are gradually increasing provision. At present there are 272,000 children in nursery schools or classes, and that is the highest number ever reached.

University of Wales

Mr. Ieuan Wyn Jones: To ask the Secretary of State for Education and Science what recent representations he has received concerning the funding of the University of Wales colleges; and if he will make a statement.

Mr. Jackson: About 500 letters have been received since the middle of last year, concerning principally the rationalisation of provision at Bangor and Cardiff. Apart from additional special allowances made for Welsh medium teaching and for the University Registry, the Welsh colleges are funded on precisely the same basis as all other university institutions in Great Britain.

Mr. Jones: Although there is a general welcome for the establishment of a Welsh committee of the University Funding Council, there is concern that the University of Wales is suffering worse cuts than universities in other parts of the United Kingdom. Will the Minister assure the House that that funding imbalance will be borne in mind when the allocation of resources is made to the University of Wales, bearing in mind the special needs arising from, first, the teaching through the medium of the Welsh language, secondly, the federal nature of universities in Wales and, thirdly, that departments tend to be smaller because of the nature of the colleges?

Mr. Jackson: I have already mentioned the special factors that are taken into account by the UGC in its allocation to Wales. It is the policy of the Government, and indeed of most parties in the House—I know it is

not the policy of Plaid Cymru, of which the hon. Gentleman is a member—that there should be a United Kingdom national policy for our universities. The University of Wales and its constituent colleges are treated in exactly the same way by the UGC as all the other university institutions in the country. The hon. Gentleman does no service to the University of Wales by asking for special pleading, especially when the University of Wales Institute of Service and Technology, Lampeter and the College of Medicine are rated above the average.

Mr. Win Griffiths: The proposal to close the education department at University college, Cardiff has absolutely nothing to do with education, but rather with Government cost cutting. Indeed, a report from the Minister's Department gave it an extremely good rating.

Mr. Jackson: The hon. Gentleman must understand that the Secretary of State fixes the number of students required for initial teacher training, but the distribution among the universities is determined by the UGC. One of the paradoxes of the situation is that the Government are accused of taking centralising powers by the very people who constantly press us to intervene to direct the universities.

School Pupils (Literacy)

Mr. Stern: To ask the Secretary of State for Education and Science if he will list in the Official Report information available to him on those developed countries that do not test school pupils for literacy at some stage before the completion of compulsory schooling.

The Secretary of State for Education and Science (Mr. Kenneth Baker): All developed countries have school-leaving examinations which reflect literacy skills. The assessment and testing arrangements to be established within the national curriculum will monitor pupils' language attainments at the key educational stages.

Mr. Stern: Does my right hon. Friend agree that the combination of that answer and the recent publication of the report of the Task Group on Assessment and Testing —the TGAT report—shows the spurious nature of the campaign that is being carried on by the Opposition parties and the teachers' unions in attacking the concept of testing, which is recognised throughout the rest of the world as an essential part of the educational process?

Mr. Baker: I am grateful to my hon. Friend for his support of the TGAT report—Professor Black's report — published last week. That report recommended assessment and testing at the key ages of 7, 11, 14 and 16. Our proposals on testing and assessment were supported in that report, and I wish to emphasise the importance of tests to determine a child's ability at those ages. If one cannot determine whether a child has literacy skills and can decipher a page of writing when he is seven, he is likely to suffer throughout his education.

Mr. Rees: Is it not the case that in other developed countries pupils at independent schools are also tested?

Mr. Baker: The right hon. Gentleman will know that the independent schools' courses are very close to the national curriculum and that those schools usually have tests and examinations on a much wider scale than we envisage for state-maintained schools.

Mr. Dickens: Is it not right that all parents should be able to expect their children at least to be able to read, write and do basic mathematics when they leave school? How can we be sure that teachers are on their toes and that children are making progress towards that end unless we test?

Mr. Baker: My hon. Friend is right in saying that we want children to be able to do all those things. Let me say a bit more about the subject. Those are the basic skills which represent the core subjects in our national curriculum. It is true that children have to be assessed and tested, which is exactly what the TGAT report says.

Mr. Bernie Grant: Will the Secretary of State tell us what measures he will take to guard against cultural bias in the tests?

Mr. Baker: The Black report refers to these matters. I am sure that the hon. Gentleman has seen the ILEA report of research undertaken before Christmas relating to the achievements of black Afro-Caribbean children in London. One thing that was discovered—and this comes as no surprise — is that many of the black Afro-Caribbean children were much more motivated to do well at school than many of the white children. They got lower grades because they lacked basic skills, and that is one of the reasons why we have put basic skills right at the heart of the national curriculum.

Mr. Sackville: Does my right hon. Friend agree that if a child is not achieving basic standards of literacy his parents have a right and a duty to find that out? Politicians and others who would stand in the way of that process do a grave disservice to children, parents and, indeed, the future of the country.

Mr. Baker: The report makes it clear that information about the assessments and tests should be made available to the child concerned—although the results should not be published so as to identify the child—to the teachers and to the child's parents, so that the necessary action can be taken. The right of a parent to know precisely how his or her child is doing is a fundamental necessity of education.

Mr. Fatchett: Given that TGAT, under the chairmanship of Professor Black, casts doubts on the validity of publishing assessment results of children aged seven, will the Secretary of State give a categorical assurance that the Government will not enact legislation to force schools to publish the results of such assessments, or are we to have a totally divisive and competitive system?

Mr. Baker: The hon. Gentleman will know from our debates in Committee that we broadly welcome the report, whose proposals are out to consultation. Professor Black's team made the point that there should be assessment and testing at the age of seven. It also said that to publish results as a judgment upon the school would not be entirely fair, and I acknowledge that there is some strength in that argument. However, it is important that the results of the tests and assessments at the age of seven should be made available to parents so that they may know how their child is doing in relation to national standards.

Education Reform

Mr. Yeo: To ask the Secretary of State for Education and Science what recent representations he has received regarding the national curriculum.

The Minister of State, Department of Education and Science (Mrs. Angela Rumbold): When the Education Reform Bill received its Second Reading, we had received a total of 9,300 letters on our national curriculum proposals. Since then we have received about 660 letters from individuals and organisations on the same subject.

Mr. Yeo: Will my hon. Friend inform the House of the number of representations that have been in favour of the national curriculum?

Mrs. Rumbold: It is difficult to say how many haw been in favour. However, our statistics can point out the way in which some of the responses were opposed. For example, we analysed the 1,312 responses from organisations on a simple basis and, in principle, only 94 were opposed. My hon. Friend will be happy to know that of the 11,790 individual responses, only 1,536 were opposed in principle.

Mr. Fisher: Has the Minister had an opportunity to read the new clause that has been tabled to the Education Reform Bill, which asks the Government to set up an Arts Education Council to promote the arts in education as part of the national curriculum? Is she aware of the great concern felt by parents, educationists and artists about the position of the arts in the national curriculum? Will she look again at the new clause and see it as a constructive way forward for promoting the arts in the curriculum?

Mrs. Rumbold: We have not yet had time to consider the proposed new clause to which the hon. Gentleman referred. However, he will know that art and music form part of the foundation curriculum that we are proposing.

Mr. Pawsey: Does my hon. Friend accept that the proposals for the national curriculum will be welcomed widely by parents, who will see them as having particular relevance to the world of work? Does she further accept that many employers will welcome them because the national curriculum will help to bridge some of the gaps that have shown up in education and caused problems in industry when young people have entered business and commerce?

Mrs. Rumbold: I am grateful to my hon. Friend for that question. Many parents are anxious to know how their children are doing. The national curriculum will assist them in that process throughout a child's school career.
Many employers have complained that some of the young people who have left school at the age of 16 and gone straight to work have not covered sufficient subjects during their education as it stands at present. The national curriculum will go a long way towards remedying that situation.

Mr. Hardy: Having grossly underfunded the introduction of the new general certificate of secondary education, will there be a similar denial of resources to schools to accompany the introduction of the national curriculum?

Mrs. Rumbold: I must advise the hon. Gentleman that the GCSE is one of the best resourced examinations ever to be introduced in this country. It was supported on a continuous basis through its pilot schemes, and when it was first introduced by several millions of pounds, so the hon. Gentleman's accusation is unacceptable. The national curriculum proposals are being looked at as a pilot programme.

Sir John Biggs-Davison: Are Ministers succeeding in removing the anxieties of religious bodies and individuals, who fear that religious instruction may be squeezed and suffer when the core curriculum is introduced?

Mrs. Rumbold: My hon. Friend knows that we are taking great care to respond to the concern of many people about the place of religious instruction in schools. Therefore, we have taken steps in our national curriculum proposals to strengthen the place of religious education in the school curriculum by strengthening the methods by which parents may have redress if they feel that religious instruction is not taking place as it was intended it should in the Education Act 1944.

Mr. Rowe: To ask the Secretary of State for Education and Science how many representations he has now received on his proposals for schools to opt out of local education authority control.

Mr. Kenneth Baker: I have received well over 900 written responses to my consultation paper from a wide range of sources, together with a variety of less formal representations.

Mr. Rowe: Does my right hon. Friend agree that a balance must be struck between providing parents with the type of school that they want for their children and the creation of establishments, the outcome of which may well be further fragmentation of society — for example, a Scientology school? Will my right hon. Friend assure the House that he will take account of such dangers in reviewing opted-out schools?

Mr. Baker: My hon. Friend will know that grant-maintained schools will not initially be allowed to change their character. We intend to table amendments to the Bill to ensure that any proposal to change the religious ethos of a school is equivalent to a significant change in character, and such a change would be subject to full public procedures.

Mr. Flannery: Is the Secretary of State aware that there is deep worry throughout the education community, and well beyond it—among parents—about the opting-out process? Is it not seen by many to be a blow struck at the local education authorities, which have been built up by a process of democracy over 100 years? Is it not an attempt by the Government to introduce private education by the back door?

Mr. Baker: The hon. Gentleman knows, because he is a member of the Standing Committee on the Bill and we are just reaching the relevant clauses, that the proposal for grant-maintained schools is designed to increase the choice available to parents. Many parents, I believe, will want to exercise that choice. There is nothing compulsory about it, and if parents and governors wish to come together and persuade the Secretary of State that a school should be grant-maintained, I see no reason why that should not be allowed.

Mr. Harry Greenway: Does my right hon. Friend agree that it was a tragic day for education when Mrs. Shirley Williams, then a member of the Labour Government, got rid of direct-grant schools? Will not the opt-out system restore that principle, not only for bright children, but for a wide educational and social range?

Mr. Baker: I think that many issues will be laid at the door of the right hon. Lady, who was one of my

predecessors when a member of the Labour Government. Not only did she destroy the direct-grant schools, but she tried to legislate to destroy the grammar schools. We stopped that in 1980.
Grant-maintained schools will not be directly analogous to direct-grant schools, but they will provide a wider variety and choice for parents. That is the choice that we want—for comprehensive, grammar, secondary modern, Church and independent schools, and now for city technology colleges and grant-maintained schools as well.

Mr. Ashdown: The Secretary of State will know that there is deep concern that, while the decision to opt out will be made by a majority of parents voting, that could nevertheless represent a very small minority of parents in the school. Will he say how many representations he has received from his own Back Benches, and what he intends to do about it?

Mr. Baker: I know that the whole House is waiting with bated breath to know exactly what the new Liberal policy is on these matters. Until the last week or so the hon. Member for Caithness and Sutherland (Mr. Maclennan) was putting forward a policy in favour of schools opting in, and he has also said that he wants them to opt out. We should like to know the answer.
When it comes to the proportion of parents voting, 51 per cent. is indeed a high hurdle. No Government since the war have been elected with such a high vote.

Mr. Madel: Is not one of the causes for a school to consider opting out the proposal by a local education authority to close a popular school whose numbers have been artificially restricted and which has been deliberately underfunded by that authority? Although my right hon. Friend cannot comment on such proposals until they reach his desk, can he confirm that he is naturally sympathetic to such schools?

Mr. Baker: I know what is behind my hon. Friend's question, and I certainly cannot comment upon it. However, if popular schools have been underfunded, other measures in the Bill will improve that as well. It is absurd to have empty desks in popular schools, and our open enrolment clauses will put paid to that practice. Obviously, many different types of school in many different circumstances will want to consider grant-maintained status, and my hon. Friend may well have identified one such circumstance.

Mr. Straw: Will the Secretary of State confirm that the overwhelming majority of the 900 responses that he has received have been opposed to the opting-out proposal and anything like it? Is the weight of opposition to the proposal the reason why the Secretary of State is rigging the balloting arrangements, so that a very small minority of parents can determine the long-term future of a school?

Mr. Baker: A figure of 51 per cent. of those voting is indeed a very high hurdle in any ballot. If the hon. Gentleman is saying that our proposals are not popular, he should recall that a Gallup poll last October indicated that 1 in 5 parents are interested in opting out. According to the most recent poll, that has risen to 1 in 3.

Mr. Haselhurst: Can my right hon. Friend say whether there will be established criteria for opting out, or whether each case will be looked at entirely on its merits, much as a section 12 notice?

Mr. Baker: I envisage each one being looked at on its merits.

Academic Research

Dr. Thomas: To ask the Secretary of State for Education and Science if he will make a statement on the state of academic research in United Kingdom universities.

Mr. Kenneth Baker: The volume and influence of Britain's academic research is second only to that of the United States of America with its vastly larger resources. We are currently reviewing our policies for the science base so as to ensure that this national strength is maintained and enhanced into the 1990s and beyond.

Dr. Thomas: Does the Secretary of State agree that this is unacceptable in view of the role of the University of Wales in the Welsh economy, with Wales getting only 1·8 per cent. of research council spending, although it has 5 per cent. of the population of the United Kingdom? Will he accept that already, to make up for the deficit in research spending in Wales, additional expenditure of at least £20 million is required? Will he address the subject as the Minister responsible for higher education and for the research councils?

Mr. Baker: The hon. Gentleman should not be so disparaging about the quality of research in Welsh universities. In the UGC's survey Cardiff was considered to be outstanding in research in mathematics and mechanical engineering. The university nearest to his constituency, Bangor, was above average in oceanography and biomolecular electronics. The amount of research money that is devoted to individual departments depends upon their excellence. The excellent ones will attract more. That is really the whole thrust of the recent change in research funding.

Mr. Summerson: Will my right hon. Friend ensure that there is proper co-ordination between the universities that are doing research into the atmosphere and the ozone layer?

Mr. Baker: Yes. Important work is being done in individual university departments on these matters. The National Environmental Research Council also has programmes in these matters and has to some extent a coordinating role in them.

Mr. Andrew F. Bennett: Can the Secretary of State explain why the morale of so many academics who are doing such excellent research is so low? Why do the Government seem only to approve of research only if it confirms their economic and political prejudices? Is it not essential that the Government pay full tribute to all our academics and build up their morale, because successful research is essential for the intellectual development of the nation.

Mr. Baker: I have tried to show my support for British science by securing an increase above the rate of inflation for next year of 6·2 per cent., from £658 million to £699 million. There were three reports on the brain drain last year which all showed that the brain drain had not worsened in 1987. I was glad to see that. By concentrating research in greater centres of excellence, which is a generally agreed policy, I think that we will get better research and more satisfied researchers. [Interruption.]

Mr. Speaker: I ask hon. Members to listen to the questions and the answers. Please let us have both brief questions and answers.

Higher Education

Mr. Watts: To ask the Secretary of State for Education and Science whether he proposes to make any changes in the funding of places for part-time students in colleges of higher education.

Mr. Jackson: The allocations of recurrent funding to polytechnics and colleges in 1988–89, announced by my right hon. Friend on 18 December, provided enhanced funding for students enrolled on certain evening courses. If the Education Reform Bill becomes law in the current Session, decisions about the funding of part-time students in polytechnics and colleges in 1989–90 and beyond will be a matter for the new Polytechnics and Colleges Funding Council.

Mr. Watts: In view of what my hon. Friend has said about the freedom of the new funding body to determine appropriate multipliers, why have the existing inadequate multipliers been enshrined in schedule 7 to the Education Reform Bill? Does that represent the Government's assessment of an appropriate level of funding?

Mr. Jackson: There has been some misunderstanding of the point. This is a welcome opportunity to make it clear. The Bill sets up the Polytechnics and Colleges Funding Council. It is required, therefore, to set criteria for the entry into the new sector of institutions. Among those are criteria relating to student numbers. When computing numbers, the question is how to count part-time numbers. That is the simple function of schedule 7, and it has no other function.

Ms. Armstrong: I had looked for a more hopeful answer from the Minister. Encouraging more people, particularly women, back into education demands a funding system that enables them to afford to do it. Will the Minister commit himself to working out ways in which more of our adults, particularly women, will be able to enter higher education?

Mr. Jackson: There was a review last year of part-time students by the National Advisory Body. It is likely that the new Polytechnics and Colleges Funding Council will wish to review the matter. Meanwhile, may I say to the hon. Lady that the proportion of women in full-time university or higher education rose from 1979 to 1986 from 38 to 42 per cent.

Rev. Martin Smyth: Will the Minister re-examine help to part-time students, bearing in mind that over the past year some people have used their time profitably to study, but that under the new social security regulations, it is not likely that they will get grants for study?

Mr. Jackson: The Government attach great importance to part-time study, and I shall certainly look at the point made by the hon. Gentleman.

Scientific Research

Mr. Dalyell: To ask the Secretary of State for Education and Science what are the implications of his policy for scientific research of the concept of curiosity-motivated research, adumbrated by Dr. Max Perutz FRS; and if he will make a statement.

Mr. Jackson: We are reviewing our policies for the science base in the light of the Advisory Board for the Research Council's recommendations on strategy and our wide-ranging consultations on those. This includes consideration of what the ABRC, Dr. Perutz and others have said about the need to support curiosity-motivated research.

Mr. Dalyell: Whose side of the argument are Ministers on at this stage; that of Sir David Philips, or that of Dr. Perutz?

Mr. Jackson: The Government are still listening to the various voices speaking on the matter. We are considering proposals made by the ABRC, and extensive representations made by numbers of other people. We have not yet reached any conclusions in the matter.

Mr. Rhodes James: Is my hon. Friend aware that what principally concerns my eminent constituent Dr. Perutz is the ludicrous concept put forward by the ABRC of three tiers of universities, the last of which would have no research at all? Is my hon. Friend aware that a university without research is a contradiction in terms, and can he categorically state that Her Majesty's Government will have nothing whatever to do with this nonsense and will reject this advice?

Mr. Jackson: There is no doubt about the importance of the ABRC's advice that there is a need for continuing selectivity and concentration in our research effort. On the particular way of approaching that, for example by way of a multi-tier structure of universities, that is a question of the means of approaching the objective of selectivity. The Government are of course considering the proposal, but it does not necessarily follow that that is the appropriate way of doing it.

Dr. Michael Clark: Does my hon. Friend agree that all good scientific research is based on curiosity and that the vast majority of scientists are motivated? Therefore, if he continues to support the science base, as he has indicated he will, will he concede that he will, therefore, by definition, be supporting curiosity-motivated research?

Mr. Jackson: There is a requirement for curiosity-based research. Fundamental research is, as it were, the header tank that feeds applied research. That is why the Government support basic research, for example by a 6·2 per cent. increase in research council funding this year.

Mr. Fatchett: While the Minister argues for selectivity in research, has he concluded that there will be universities without research activities and functions, and if he has come to that conclusion, does he find that acceptable for any of our universities?

Mr. Jackson: The Government have reached no conclusions in the matter. The principle of the necessary presence of research in university institutions is one that the Government understand, although I must point out to the hon. Gentleman that more than half the students in higher education in this country are educated in institutions whose mission does not embrace basic research.

Education Reform

Mr. Janner: To ask the Secretary of State for Education and Science what representations he has received from Leicestershire concerning the Education Reform Bill.

Mrs. Rumbold: The Department has received about 70 representations from organisations based in Leicestershire, and many others from individual correspondents. All representations, except for those from individuals, have been placed in the Library of the House.

Mr. Janner: Is it not right that the vast majority of representations made from the county of Leicestershire, including the representation of the Conservative-controlled Leicestershire county council, are powerfully and vigorously against most of the recommendations in the Bill? Is the Bill not regarded by most people in the county as divisive, removing or reducing local powers and doing nothing whatever to assist the education authorities and other groups to meet the growing needs created by the cuts that the Government have imposed on our county?

Mrs. Rumbold: The hon. and learned Gentleman will be disappointed to know that the representations that we have had have been nothing like as categorical as he has insisted they are. Indeed, the majority of the representations that we have had may have objected parts to some of our reform Bill, but they have accepted other parts. No such categorical statement on the whole of the Education Reform Bill as he suggests has been received by the Department.

Mr. Ashby: Is my hon. Friend aware that in fact Leicester county council is controlled by the Labour party and the alliance together, not by the Conservatives, as the hon. and learned Member for Leicester, West (Mr. Janner) said? Is she also aware that that council does not allow parents to send their children to local education authorities in other areas, across the border, as it were? Has she had any representations from parents who find that there are schools just 100 yards down the road to which they cannot send their children, but instead have to send them sometimes seven miles or more to school? Has she had any representations requesting inclusion in the Education Reform Bill of freedom of choice across borders?

Mrs. Rumbold: Our proposals within the Education Reform Bill on the matter of open enrolment will certainly mean that parents will have an opportunity of ensuring that they get the school of first choice for their children. This is an extremely important principle of freedom of choice for parents. I am a little surprised to learn from my hon. Friend that the authority is not allowing children to cross boundaries, because it is my understanding that there is the ability for children to cross boundaries under present legislation.

O-Level Examination Results

Ms. Ruddock: To ask the Secretary of State for Education and Science whether he will give the proportion for each year since 1979 of (a) girls and (b) boys taking O-level mathematics, craft, design and technology, and physics, who obtained grades A and B.

Mr. Dunn: Over the period 1978–79 to 1985–86, the percentage of school leavers in England who had gained


grades A-C in GCE O-level and grade 1 CSE has shown an increase in mathematics, craft design and technology and other science, and physics. Since 1978–79 more boys than girls have gained a higher grade in each of these subjects, but the proportion of those doing so has increased at a faster rate for girls than for boys. I shall publish the information asked for in the Official Report.

Ms. Ruddock: I thank the Minister for that answer. I hope very much that he shares my concern that boys are still achieving more highly than girls in science and mathematics subjects. Given that there is evidence, in mixed schools particularly, that there is an apparent lack of interest in and aptitude for science in girls as compared with boys, and given that the national curriculum will make those subjects compulsory for all, what specific plans does the Minister have to ensure that interest in those subjects by girls is encouraged and to help teachers avoid the presentation of science as a masculine pursuit?

Mr. Dunn: We have specifically asked the mathematics and science working groups that are advising on

School leavers, England



Percentage of leavers with a higher1 grade at O-level or CSE in



Mathematics
Physics
CDT and other science2


Academic year
Boys
Girls
Boys
Girls
Boys
Girls


1978–79
29·2
22·3
18·9
5·8
18·1
3·0


1979–80
29·2
23·2
19·4
6·3
18·2
3·1


1980–81
30·0
24·3
20·0
7·4
18·2
3·0


1981–82
31 3
25·7
21·0
8·1
18·6
3·1


1982–83
31·9
26·9
21·5
8·4
18·2
3·2


1983–84
32·6
27·7
21·8
8·8
18·6
3·3


1984–85
33·2
27·9
21·9
9·5
17·9
3·4


1985–86
33·3
27·8
21·9
9·4
17·7
3·8


Source:


School Leavers Survey· Data subject to sampling error. The data exclude CSE-GCE achievements of young people at tertiary and other FE colleges.


1 Higher grades are 0-level grades A-C and CSE grade 1.


2 CDT and "other science" comprises: craft, design and technology; agriculture, horticulture or rural studies; technical drawing; building engineering plumbing; metalwork; woodwork; general science.

Student Grants

Mrs. Mahon: To ask the Secretary of State for Education and Science whether he will amend the student awards regulations so that married women are no longer dependent on their husband's income for grant purposes; and if he will make a statement.

Mr. Jackson: No. The Government consider that, where the husband or wife of a student has the means to contribute to the student's maintenance costs, it would be wrong to increase the share of those costs which is borne by the taxpayer.

Mrs. Mahon: Does the Minister realise that the discriminatory nature of the present system prevents many mature women from returning to higher education? Does he not think that it is time for a change in the present system?

Mr. Jackson: I must point out to the hon. Lady that there has been a substantial increase in the number of women university students between 1979 and 1986, from 38 to 42 per cent. It is a basic principle of the system of

attainment targets and programmes of study to bear in mind that the curriculum should provide equal opportunities for boys and girls and to consider In their work the expectations and aptitudes of girls with regard to those subjects.

Mr. Nicholas Bennett: Does my hon. Friend agree that what is important about children's examination results is not the gender of the children but the authority to whose schools they go? Some of the highest spending authorities in this country have the worst examination results.

Mr. Dunn: My hon. Friend is entirely right. Our proposals in the Education Reform Bill will, of course, bite on all education authorities, irrespective of their political nature.
Following is the information:
Information is not available in the form requested. The proportion of school leavers in England who had gained a higher grade at O-level or CSE in mathematics, physics or CDT and other science is shown in the following table:

student support, which is of course being reviewed by a committee that I am chairing, that the family should support the student, whether it is the parents or the spouse.

Oral Answers to Questions — PRIME MINISTER

Engagements

Mr. Rowe: To ask the Prime Minister if she will list her official engagements for Tuesday 19 January.

The Prime Minister (Mrs. Margaret Thatcher): This morning I had meetings with ministerial colleagues and others. In addition to my duties in the House, I shall be having further meetings later this afternoon. This evening I am speaking at the Britain-Australia Society's bicentennial celebration at the Guildhall.

Mr. Rowe: Will my right hon. Friend find time today to consider the many opportunities that could exist, but which are not being made available to volunteers of all ages, to assist the public services? Will she ask her Ministers to reconsider the work of their Departments to make available more opportunities to the many thousands who would like to contribute on an organised basis?

The Prime Minister: I agree with my hon. Friend that voluntary work has a great deal to contribute to our community life, and I think that the number of voluntary organisations is one of the characteristics of life in this country. I know how much voluntary work contributed to the clearance after the recent hurricane in my hon. Friend's part of the world. I shall, of course, ask Ministers to consider the matter again to see if they can do more.

Mr. Kinnock: If, as we are told, the Government have the money to cut taxes, why do they not the money to cut the waiting time for those children now in urgent need of vital operations?

The Prime Minister: The number of children being treated now, particularly for cardiac surgery, has increased enormously. Indeed — [Interruption.] — for every five cardiac operations that were carried out up to 1979, about eight or nine are carried out now.

Mr. Kinnock: May I say to the Prime Minister, in the words of Mr. Steve McCallum, a member of the west midlands "Young at Heart Campaign" yesterday that
We are not political."—
[Interruption.] The parents of children needing cardiac operations will have heard Conservative Members laughing at those words. They continue:
We are fighting for the lives of children. Children's lives are more important than party politics. We don't want to hear figures and statistics quoted for this year and that year. What we want is a National Health Service, a Birmingham Children's Hospital and the best service they can get.
Did the Prime Minister refuse to see Mr. McCallum and other parents and their children yesterday because she knew that if she did she would hear home truths like that?

The Prime Minister: I shall give the right hon. Gentleman the figures that he does not want to hear. He does not want to hear them because they are so good. Cardiac operations at the Birmingham children's hospital are up by 86 per cent. since 1978. In 1978 there were 155. In 1987 there were 288. The right hon. Gentleman says that he does not wish to use these matters party politically. That is the record. May I point out that one of the cases that were prominent in the House last week—that of Matthew Mulhall—was also mentioned again on Friday and it was pointed out that Matthew had a leaking heart valve and that his consultant advised his parents that it would be
best to allow him to grow so that the largest possible replacement heart valve can be used.
It was envisaged that his operation would take place in four to six months' time. Finding the facts did not stop people falsely raising that case in the House.

Mrs. Ann Winterton: Does my right hon. Friend agree that the £10·5 million of taxpayers' money being spent on the Commission for Racial Equality, the £3·4 million being spent on the Equal Opportunities Commission and the £2 million being spent on courses for trade unionists at our colleges would be better spent on the nation's health?

The Prime Minister: It has been our policy to do as much as we can to see that there is equality of opportunity in Britain, but I am sure that my right hon. Friend the Chief Secretary will have heard my hon. Friend's very effective question.

Mr. Fearn: To ask the Prime Minister if she will list her official engagements for Tuesday 19 January.

The Prime Minister: I refer the hon. Gentleman to the reply that I gave some moments ago.

Mr. Fearn: As tourism is the fastest growing industry in the world, will the Prime Minister confirm that funds will be available for the British tourist industry, and, indeed for the north-west of England, which is the most beautiful part of Britain? When the Prime Minister replies, will she smile? I have been here seven months and I have never seen her smile yet.

The Prime Minister: I agree with the hon. Gentleman that tourism is an important and growing industry. Last year it helped to create 44,000 new jobs. My right hon. Friend the Secretary of State for Employment has announced that support for tourism will increase next year by 9 per cent., bringing the total up to nearly £50 million. Allocations to the regional boards, including the northwest, are now being considered.

Mr. Cash: Has my right hon. Friend noticed the report in The Times today about an unemployed man who started out with the enterprise allowance with a zero turnover, but who, in the space of nine months, has increased that to £560,000 a year? Does that not prove that under her Government enterprise is thriving in Britain and will continue to do so?

The Prime Minister: I am aware of that case. The enterprise allowance has been an enormous success and has enabled many young people to start up in business on their own, creating not only jobs for themselves but for many others, showing that enterprise and vitality are still very much present in Britain's young people.

Mr. Boyes: To ask the Prime Minister if she will list her official engagements for Tuesday 19 January.

The Prime Minister: I refer the hon. Gentleman to the reply that I gave some moments ago.

Mr. Boyes: Exactly why would the Prime Minister not meet the parents of children who came to see her yesterday about their children's urgent and desperate need for heart surgery?

The Prime Minister: We do not normally receive petitions. There are quite a large number. As the hon. Gentleman is aware, we usually carry out between eight to 11 engagements in one day. There was a most excellent debate late on Friday afternoon on the Birmingham children's hospital, which met most of the points that were raised by the parents.

Mr. Dickens: If I were to—[Interruption.]

Mr. Speaker: Order. Mr. Dickens.

Mr. Dickens: If I were to ask my right hon. Friend to give the House the recipe for the splendid performance of the British economy, what main essential ingredient would she list?

The Prime Minister: If my hon. Friend will allow me two, not one, I would say—[Interruption.]

Mr. Speaker: Order. It is a perfectly legitimate question.

The Prime Minister: If he will allow me three and not one, I suggest: sound financial policies each and every year, the right legal framework, and incentives to enterprise.

Dr. Thomas: To ask the Prime Minister if she will list her official engagements for Tuesday 19 January.

The Prime Minister: I refer the hon. Gentleman to the reply that I gave some moments ago.

Dr. Thomas: Will the Prime Minister take time today to study the representations made to the Government by the Irish Government and the European Commission about a proposal by the CEGB to undertake a test in Trawsfynydd power station in my constituency on 12 February, which will include operating the reactor without the normal cooling procedures? Will she respond to those representations and clearly tell the Secretary of State for Energy and the CEGB that such a test does not pass the test of community acceptability in the community that surrounds the power station? If she or the Government allow that test to go ahead, would she, because of her great commitment to nuclear power, like to attend the test and supervise it in person?

The Prime Minister: Much better than that, as I am sure the hon. Gentleman will agree, the test will take place only with the full approval of the independent Nuclear Installations Inspectorate, and will be monitored by it. It will be carried out only after the reactor has been fully shut down for its statutory inspection. All automatic safety systems will be operating normally. No safety systems will be cut off. I understand that there have been two similar tests in the past.

Mr. Hayes: Will my right hon. Friend cause strong representations to be made to the American Government for allowing Seamus Twomey, a former chief of staff of the IRA, to be feted at a banquet in New York for raising funds for Noraid?

The Prime Minister: I am aware of my hon. Friend's strong views. I think we all feel strongly about this, but the American Administration and President have been forthright in condemning anyone who pursues violence as a way of achieving a political objective. The President has done everything possible to make it clear that that is wholly unacceptable.

Mr. Steel: It is—[Interruption.] It is always good to see enthusiasm. Is the Prime Minister aware that tomorrow a delegation of Scottish local authorities is coming to the House to protest at the sheer cost of introducing the poll tax north of the border? Is she aware that the £12 million that the Government have given in no way meets the £25 million of the cost of the administration? Would not that money be better spent on the Health Service in Scotland?

The Prime Minister: The community charge is a way of paying for local government which properly distributes the payment over a wider number of people. In fact, it meets only about a quarter of local expenditure. As the right hon. Gentleman is aware, the other three quarters is met by industry and the taxpayer.
The enthusiasm that the right hon. Gentleman heard expressed was because we thought he might be asking, or telling us, about his policy.

Mr. Allason: When my right hon. Friend considers the Government's much-awaited reform of section 2 of the Official Secrets Act, will she give serious consideration to formalising the role of the D-Notice committee and, in

particular, consider introducing a publications review board along the lines of the one that has worked so well in America?

The Prime Minister: My hon. Friend had best wait until the White Paper comes out. We expect it to be out in about June.

Mr. Bill Michie: To ask the Prime Minister if she will list her official engagements for Tuesday 19 January.

The Prime Minister: I refer the hon. Gentleman to the reply that I gave some moments ago.

Mr. Michie: Is the Prime Minister aware of early-day motion 310, bearing 142 signatures, in which it is claimed that 25,000 signatures have been collected to fight to keep open the Nether Edge maternity unit in Sheffield? How can she justify her statement that the Health Service is safe in her hands when, in spite of all the pressures and arguments, the unit will still be closed? Will she personally meet a delegation from Sheffield and deal with the situation?

The Prime Minister: This is a matter for my right hon. Friend the Minister for Health and for my right hon. Friend the Secretary of State for Social Services, who deal with such matters. However, the hon. Gentleman will he pleased because I understand that a new children's hospital will he opening in Sheffield next year.

Mr. Marlow: Unlike the leader of the Labour party, Conservative Members are not worried about elections, but supposing that at the next general election the electorate should make a slight mistake and not give us a overall majority, what lessons would my right hon. Friend learn from last week about trying to form a coalition with the Social and Liberal Democrats?

The Prime Minister: That is a mistake that the Conservative party will not make.

Mr. Wall: To ask the Prime Minister if she will list her official engagements for Tuesday 19 January.

The Prime Minister: I refer the hon. Gentleman to the reply that I gave some moments ago.

Mr. Wall: Is the Prime Minister aware that only six out of 12 intensive care beds are in use for heart operations in the Yorkshire regional cardiothoracic centre at Killingbeck hospital in Leeds? Will she join the vast majority of senior medical staff at that hospital in requesting from the regional health authority three extra intensive care units, or will she tell the staff at that hospital who, in the vast and lengthening queue of patients, young and old, will have to wait for surgery?

The Prime Minister: The number of cardiac operations, the amount of resources and the number of doctors and nurses have greatly increased. We are looking carefully at why some regional and district health authorities are able to manage much better than others on their allocations of money, and why in some surgery wards in some hospitals the beds are left empty between patient treatment for one day while in others they are left for up to three days. We are now getting a great deal of interesting information, trying to make the best use of the facilities available and taking lessons from those who have been most successful in that.

Points of Order

Mr. Tony Banks: On a point of order, Mr. Speaker. There is a report in today's Financial Times saying:
the Home Secretary is expected to outline his plans for the expansion of UK radio in Parliament today.
It is a matter of great discourtesy that those proposals will be outlined in Parliament by way of a parliamentary question that was tabled yesterday, the answer to which will be available between 4 o'clock and 4.30 this afternoon. This is part of the consultation process.
The Government have issued a Green Paper about the future of radio broadcasting in Britain. It would be normal procedure to expect a White Paper and certainly a statement from the Home Secretary at the Dispatch Box to enable us to discuss matters of great significance and importance for broadcasting in Britain. I have not seen the planted reply, but I understand that we are to hear about three new national stations which will be auctioned off. There will be major changes.

Mr. Speaker: Order. I know nothing about this matter. If we had had a statement today on this issue it would have delayed the start of the debate, in which I have the names of no fewer than 58 right hon. and hon. Members wishing to speak. There is nothing I can do about the hon. Member's comments.

Mr. Bob Cryer: On a point of order, Mr. Speaker. The Register of Members' Interests is important for the operation of certain Standing Orders. The Select Committee on the Register of Members' Interests announced on 8 December that it had agreed on its publication. That document has not yet appeared. It is important that it is published so that we can see whether Tory MPs who accuse nurses of moonlighting are themselves moonlighting by an extensive range of directorships and parliamentary adviserships, like the right hon. Member for Chingford (Mr. Tebbit).

Mr. Speaker: I understand that the Register is available for inspection in the Library, but I will look into the matter that the hon. Gentleman has raised.

Mr. Bill Walker: On a point of order, Mr. Speaker. I seek your guidance as a member of the First Scottish Standing Committee. This morning we were unable to conduct our business—

Mr. Speaker: Order. I cannot give any guidance to the hon. Gentleman on that. As I stated last week, in answer to a broadly similar point of order, what goes on in a Standing Committee cannot be raised with me on the Floor of the House.

Mr. Tony Banks: Further to that point of order, Mr. Speaker—

Mr. Speaker: Order. There is nothing further to it at all. I say to the hon. Gentleman that he has made his point. I can do nothing about it. It is not a matter for me. It is not a matter of order. Ten-minute Bill—

Mr. Banks: rose—

Mr. Speaker: No. I say again to the hon. Gentleman that I cannot hear any more on that matter.

Underground Fires (Research and Control) and Land Protection

Mr. Harry Barnes: I beg to move,
That leave be given to bring in a Bill to improve research into and services directed towards the prevention, combat, control and extinction of underground fires; and to protect land affected by such fires from consequential damage from subsidence.
Before referring specifically to the modest scope of the Bill I am seeking leave to introduce, I wish to place into a wider context the problems the Bill will seek to tackle, which I hope will illustrate the importance and significance of the measures I propose. There are two main reasons for seeking to extend and co-ordinate expertise in handling natural disasters or acts of God; the types of incidents associated with floods, gales and certain fires. First, complexities arise from the rapid technological changes which are taking place around us, or at least apart from in the Chamber.
Centralised aid and back-up facilities are required to monitor, prevent and, if things go wrong, handle local disasters such as the floods affecting Strabane in Northern Ireland, which could arise in complex new harbour developments such as the Felixstowe dock. The gales which recently hit the south could hit high-rise, man-made structures or complex chemical and nuclear plants. Fires can hit complex underground workings and facilities.
The coal mining industry has had 80 cases of heating in the past year and has a long tradition of fires that require stoppings to be placed within pits. The new technology of Selby-type developments means that the problems associated with such fires are extended. The recent King's Cross disaster revealed massive problems in handling underground fires where passages act as wind tunnels, producing unmanageable fires. Bodies such as the Fire Brigades Union have produced well-documented figures on potential accidents and fire incidents in the proposed Channel tunnel.
Apart from these many technological factors, a second set of problems is faced in handling such disasters—the cuts in local government funding. There have been cuts via the rate support grant, and rate capping and grant capping in Derbyshire. Now we are to have the poll tax and the unified business rate, all pushing down the provisions and facilities for local government services, unless the House can prevent the latter development.
Emergency services dealing with nuclear waste, chemical explosions, extensive floods, sweeping gales or fire hazards could be sustained, even in a less than adequate form, if the Department of the Environment established units to provide research and back-up to help prevent or combat the situations I have touched upon.
I concentrate my remaining remarks on underground fires and the need for my Bill. The definitions of three categories of underground fires should be established: the man-made tunnel with supporting walls, such as the Mersey tunnel; the tunnelling exercise to establish those provisions, including mining activities, where roof support is the only method of protection; and underground fires in closed, confined areas where there is no direct access by individuals, such as the fire in the coal seam which occurred at Oakthorpe in Leicestershire and the fire at


Dronfield in my constituency, where waste material caught alight under an industrial estate that had been constructed out of waste. The last category could also include other potential sources of fire where gas pipes, oil resources and the like are ignited. It is the final category of enclosed underground fires that my Bill will deal with. The available expertise in handling other underground incidents will need to be brought into consideration by the structure that is set up in the Bill. I am seeking the setting up of a special unit under the supervision of the Department of the Environment, whose services and resources of expertise can be drawn on by local authorities that are now faced with complex matters that go beyond their normal experience and expertise.
At the moment, an interdepartmental committee, which is serviced by the Department of the Environment, is discussing the redevelopment of contaminated land. In July 1986, it produced a second draft of a paper on the fire hazards of contaminated land. It dealt with the main hazards of underground fires and listed them as:
1. Production and release of toxic … noxious gases which can travel considerable distances through the ground; 2. subsidence of the burnt ground, causing physical damage to any buildings or other structures on or near the site of the fire, and creating hidden cavities which may make tackling the fire or reclaiming the land hazardous; 3. heat damage to buried structures and site services, such as power supply cables.
It continues:
All these hazards are dangerous on derelict sites and much more so on sites which are being or have already been developed. After development has been completed, it may be more difficult and expensive to repair the damage.
The final points made in the report are exactly illustrated by the problems that arose in my constituency in the underground fire at Dronfield.
A lead is required to introduce this measure, and I hope that it will be used and built upon in future after the appropriate unit has been established in the Department of the Environment to begin to tackle some of the wider hazards that I have mentioned associated with floods, fires and gales.
I hope that the Bill will gain general support in the House.
Question put and agreed to.
Bill ordered to be brought in by Mr. Harry Barnes, Mr. John Cummings, Mr. Harry Cohen, Mrs. Alice Mahon, Mr. Jeremy Corbyn, Mr. Frank Cook, Mr. Martin Redmond, Mr. Don Dixon, Mr. Bernie Grant, Mr. Alan Meale, Mr. Dennis Skinner and Mr. John Battle.

UNDERGROUND FIRES (RESEARCH AND CONTROL) AND LAND PROTECTION

Mr. Harry Barnes accordingly presented a Bill to improve research into and services directed towards the prevention, combat, control and extinction of underground fires; and to protect land affected by such fires from consequential damage from subsidence: And the same was read the First time; and ordered to be read a Second time upon Friday 22 April and to be printed. [Bill 83.]

Opposition Day

7TH ALLOTTED DAY

National Health Service

Mr. Speaker: Before the debate on the National Health Service, I must announce that I have selected the amendment in the name of the Prime Minister. I should repeat what I said earlier in answer to a point of order: no fewer than 58 right hon. and hon. Members have written to express their interest in speaking in the debate, and there may be others. Many of them are Privy Councillors, so I make a special plea for brief contributions.
The House has not given the Chair authority to limit speeches to 10 minutes, but it would be helpful if all Back-Bench speeches could be limited to 10 minutes on this motion.

Mr. Robin Cook: I beg to move,
That this House notes that two out of three health authorities anticipate a deficit at the end of the current financial year and that attempts to balance their accounts have produced closures of hospital wards and cancellation of operations; affirms its commitment to the principle of a National Health Service providing comprehensive, free treatment to all citizens on the basis of need, not payment; further notes that current Treasury revenue substantially exceeds expenditure; and therefore calls upon Her Majesty's Government to release additional funds to end the financial crisis in the Health Service, and to drop proposals for new charges for dental examinations and for eyesight tests.
This is the second occasion on which the Opposition have named health for their Supply debate within the past two months. I wish to advance three reasons why we took the view that it was not only appropriate but essential that the House should have an opportunity to return to this vital matter today.
The first reason is the evidence, accumulating since we last debated the issue only two months ago, that the NHS is currently in financial crisis. Indeed, the weight of evidence pointing to that financial crisis is now so massive that even the Law Officers of this Government must be considering advising their client to plead guilty. May I produce the witnesses who have come forward in the past two months since we debated the issue to confirm the state of crisis in which they have to operate?
The first witness is the chairman of the consultants' committee of the British Medical Association. Last month he announced that that committee was setting up a survey of the acute specialties and he said:
The acute sector is falling apart at the seams.
The director of the Association of Community Health Councils published its survey only this month. That survey showed that 56 out of 113 health authorities proposed to close wards — some of them entire hospitals — in this financial year. The director stated:
Unless there is action now, some parts of the NHS, already on the brink of collapse, will simply fall apart during 1988.
In Oxfordshire, 296 general practitioners signed an advertisement opposing the closure of 140 beds. That advertisement said:
These cuts will cause considerable suffering and very possibly hasten death in some patients.


Consultants at St. Mary's hospital, Paddington wrote to the press saying:
We have a duty to inform the public that the fabric of the NHS is crumbling about us.
Consultants at the Birmingham children's hospital wrote to the press stating that they now turn away 30 acute cases every week, and added:
We no longer accept that this service is safe in the Government's hands.
Most damning of all was a statement, not by any doctor or any nurse or even by Brian Redhead of the BBC, but by the hospital manager of the Manchester royal infirmary last week. He wrote to the 2,500 employees of that hospital advising them that he could no longer pay for drugs and that, by the end of the financial year, he may no longer be able to pay for their wages. He added:
To all intents and purposes we are bankrupt. If we were a commercial organisation we would have gone into voluntary liquidation".
The Government pride themselves on introducing a commercial ethos into the NHS. They have now achieved a new first — they have introduced the concept of bankruptcy into the NHS. Looking at the amendment in the name of the Prime Minister and her colleagues, I am astonished that it has the nerve to express their support for the dedicated staff of the NHS. If the Government have such respect for the staff of the NHS, they should listen to what those staff are saying to them day after day.
In truth, in the past two months, the Government have sought to pin the blame on the very staff who work in the NHS. Last month, it was the fault of the consultants. Bernard Ingham, the true voice of the Government, briefed the press on the basis that too many consultants were nipping off to do private practice. I find it breathtaking that the Government, who have done everything possible to encourage consultants to do more and more private practice, should now identify that as their excuse. In 1980, the Government even changed the consultants' contracts so that those full-time NHS consultants might carry out private practice in the time when they are paid a full-time salary by the NHS. However, I welcome the Government's repentance and their belated recognition of the fact that, if one extends private medicine, the people who are neglected are the patients on the NHS waiting lists.
Such private practice by consultants is not the major source of the current crisis. At present, all round Britain, health authority managers are telling consultants to slow down and to cut their output. They are being told to go off to the golf course, do a spot of gardening, do anything but increase the rate at which they operate on their waiting list. Indeed, at the Queen Elizabeth hospital in Birmingham some surgeons have been instructed to carry out 10 per cent. fewer operations next year than this year.
Last week a new culprit was discovered. The right hon. Member for Chingford (Mr. Tebbit), who is to grace us with a speech in this debate, discovered that it was not the consultants but the nurses who were to blame—with a little help from the BBC. The right hon. Gentleman informed us that too many nurses were moonlighting. There is a fat lot of support for the dedicated staff of the NHS in that statement. I am not entirely sure that I follow the right hon. Gentleman's logic. Presumably, if those nurses stopped moonlighting, the staffing crisis in our

hospitals would be even worse. However, I bow to the right hon. Gentleman's superior knowledge of moonlighting.

Mr. Norman Tebbit: If the hon. Gentleman had listened to what I said, he might have perceived—although it is doubtful, as his abilities in that respect are limited—that my objection was to the crazy system in the Health Service which frequently precludes nurses from working overtime in their own hospitals but allows them to work overtime as agency nurses in another hospital. While a nurse is doing that, a girl from a second hospital is busy working overtime as an agency nurse in her hospital. That is my objection.
On moonlighting, Opposition Members might benefit from doing a little themselves. It might add to the debate if we had a bit more moonlighting and a little less moonshine.

Mr. Cook: I would acquit the right hon. Gentleman of the charge of merely having moonlighted. Since he retired as chairman of the Conservative party, he has gone through the whole galaxy of night-time work. On the explanation that he has offered of his speech on Friday, I am bound to say that if that was what the right hon. Gentleman intended to convey to the press, he signally failed to choose the correct words to put his message across.
Furthermore, NHS nurses do not fail to do overtime in their own hospitals. If the right hon. Gentleman had followed the documents that have been cascading from the professional bodies for the past two months, he would have seen the survey carried out at the request of the Royal College of Nursing by independent surveyors, who discovered that 60 per cent. of nurses did an average of five hours a week unpaid overtime in their own hospitals. Those are the people whom the right hon. Gentleman maligns.
At the weekend, the nurses were superseded by a new culprit. I was distressed to read that my opposite number, the Secretary of State, is now being fingered as the culprit. I feel a personal sense of involvement in seeking to acquit the Secretary of State. I am glad to see him back at the Dispatch Box and looking so well. It is as well that I should put that on the record, because it is not immediately apparent that all his colleagues feel the same. The charge being made in the alcoves of the Westminster bars is that he has created chaos out of order single-handedly and in seven months—taking two months off for illness the while. Think what he could have achieved had he remained in good health throughout the seven months. It is a ludicrous charge. The crisis that has erupted in the past few months has been years in the brewing.
Yesterday, I took part in a radio package in which the hon. Member for Reading, East (Sir G. Vaughan) also participated. The hon. Gentleman was Minister for Health during the first three years of this Government's period in office. I praise him for his refreshing candour and honesty. On "The World at One" yesterday the hon. Gentleman said:
We have known this would be crisis year since 1981.
They knew it was coming. They did nothing to avert it. They deliberately planned the financial squeeze that gave rise to the current crisis.
I have no doubt that we shall again hear figures showing the growth in the NHS budget. I invite right hon. and hon. Members to bear in mind that one third of that


increase took place before 1981 and was almost entirely attributable to the Clegg awards. Most of the increase since 1981 has taken place outside the hospital sector, among the family practitioner services, which are, of course, demand-led. We can see what would have happened to expenditure on those services had they been cash-limited by looking at what did happen to the hospital sector during the same period. In 1986, the Select Committee on Social Services reviewed the hospital budget between 1981 and 1986 and concluded that, in volume terms, the increase was 3·1 per cent. over the entire five years.
The Minister for Health has answered a question pointing out the demographic pressures on the hospital budget and quantifying it in percentage terms. During those same years, when the hospital budget increased by 3·1 per cent., on the Minister's own figures, demographic change added a 4·3 per cent. burden to the hospital sector alone. We do not have a report from the Select Committee for 1987, but it is possible to update those figures. Indeed, the King's Fund has done so and has identified a 3·4 per cent. increase in volume terms over the six years 1981–87 and a 5·4 per cent. increase in the pressure from demographic change during the same period.
Demographic change is racing ahead by two thirds of the increase in the budget of our hospitals. That is why they are now in crisis. That is why wards are closing and patients are being turned away. However, these are statistics that the Prime Minister has chosen not to use in her weekly exchanges with my right hon. Friend the Leader of the Opposition.

Mr. Eric Forth: Will the hon. Gentleman give an undertaking that, if the Labour party is elected to government in the future, it is prepared to commit sufficient funds to the National Health Service to eliminate waiting lists totally? If he is prepared to give that undertaking, which flows from the logic of his argument, will he estimate the cost of that? If he is not prepared to give that undertaking, will he tell us which elements of the waiting lists he is prepared to live with and which he would prefer to eliminate?

Mr. Cook: Only last week, my right hon. Friend made a clear statement of the five points that we are putting forward as our commitment to the NHS. Those commitments have been costed. They mean making good the reduction in expenditure in the hospital sector during the past six years. They involve a planned and controlled expenditure increase to reduce waiting lists, rather than the ad hoc, one-off cosmetic gestures that we get from the Government.
There are other statistics which the Prime Minister chooses not to use, which shed a different light on the record of her Government. However, those statistics occasionally slip out when the guard is down. My hon. Friend the Member for Huddersfield (Mr. Sheerman) obtained an interesting answer last week, which showed that expenditure on nurse training has decreased from £479 million in 1979 to £439 million in 1986. That is one reason for the staffing crisis in our hospitals.
There are also the accelerating figures on bed closures in acute specialties. During the Government's first three years, we lost 5,000 beds for acute specialties. I concede straight away to the Secretary of State that that was more or less on trend with the long-term decline in the number of beds for acute specialties.

Mr. Tony Marlow: Will the hon. Gentleman give way?

Mr. Cook: No, I shall continue my speech.
During the next four years, we lost over 10,000 beds for acute specialties and last year we lost 5,000 acute specialty beds. That is three times the rate for the figure for only eight years earlier —[Interruption.] I am asked about waiting lists. Well, the waiting list for March 1987 was 15,000 higher than for the year before. We do not yet have the figure for September 1987 but, so far, every waiting list figure for September under this Government has been higher than any September figure under the previous Labour Government.
We also have the figures for infant mortality. Last year, alone among Western nations and for the first time since 1970, infant mortality increased in Britain. When the Prime Minister was taxed about that a fortnight ago, she was so shocked by the increase that for once she lost her confidence in statistics and said:
It may well be that it is a statistical error."—[Official Report, 12 January 1988; Vol. 125, c. 141.]
I am afraid that there is no statistical error. However, I can say that the Prime Minister was absolutely right to point out that the increase did not take place in the first four weeks after birth—which is the period of intensive medical care — but in the subsequent 11 months, between the first and the 12th month of life: the post-neonatal period. I have before me a press statement by Peter Pharoah, professor of community health at Liverpool university, who said:
Post-neonatal deaths are much more affected by social factors such as unemployment, housing conditions, low income".
That brings us to another set of statistics about the present Government. Survey after survey shows that unemployment makes people ill. The unemployed are 40 per cent. more likely to suffer from cancer, and 200 per cent. more likely to commit suicide. Even the wives of unemployed men have a higher mortality rate, and their children have a higher infant mortality rate. The current rate of unemployment, in the calculation of the British Medical Journal, causes an additional 3,000 deaths a year.
If the Government wish to trade statistics, there are plenty with which we can cap any that they produce. Ultimately, however, the trading of statistics is an exercise as sterile as any operating theatre in the National Health Service. Whether the position is better or worse than in 1979 is an argument of obsessional interest to professional politicians, and to just about no one else. People outside this Chamber see their wards closing and their operating theatres being shut down. They see a real problem, and they want to hear a solution to it. They may well have the wit to work out for themselves that those wards and operating theatres stayed open throughout the period of the last Labour Government. However, they are not interested in comparisions with the past; they want to know what plans have been made for the future.
That brings me to the second reason for returning to the issue. It is now clear that the Government are planning on the expectation that the coming year will be even worse than the one that we have just been through. On 18 November, the two junior Health Ministers met the regional health chairmen in Cambridge. One of the chairmen said afterwards:
The chairmen went in to hang the table and make sure ministers understood just how bad things are out there There wasn't any need.


The two Ministers
just acknowledged it and said in effect it was going to get worse".
I have with me the letter that the Minister for Health subsequently sent to the chairmen of the regional health authorities. I do not believe that he has yet placed it in the Library; perhaps he will do so after the debate. The letter is, of course, beautifully crafted by some civil servant and written in coded terms, but it is not difficult to break the code and decipher what is meant by the "need for realism" or
more rational use of resources".
Paragraph 3 of the letter makes it clear that there will not be a penny more for 1988–89, while paragraph 6 states that there will be the same pressure for cost improvement programmes in the next year. The Minister accepts that
some of the more obvious things have now been done and that attention will increasingly need to be given to the cost effective use of clinical resources.
In other words, cost improvement programmes will shift this year from ancillary services to patient care.
Paragraph 8 makes it clear that the health authorities must plan on the expectation that pay increases will not be fully funded this year:
Authorities will therefore need to plan flexibly and recognise that they may well be called on to meet some pay and price pressures in 1988/89.
For "may well", we may read that they can bet their bottom nurse that that will happen.
I have a letter from the North-West regional health authority, which was sent out following that circular, instructing every district health authority in the north-west to cut its real budget by 1·5 per cent. next year. That of course includes Manchester royal infirmary. All the chairmen in the Yorkshire health authority area were summoned to a meeting with the regional chairmen on Friday, and instructed to cut their budgets by 1 per cent. in the next financial year. I have before me the papers put before Bloomsbury district health authority last week, which show that, in the coming financial year, there will be an additional shortfall of nearly £3 million.

Mr. Max Madden: My hon. Friend referred to Yorkshire. Is he aware that Bradford health authority, in a document that was leaked this week, is shown to be planning to cut health services by more than £3 million over the next two years. The infant mortality rate in the city is twice the national average, and the authority plans to close a maternity unit. Heart illness is way above the national average, and it plans to cancel the appointment of a second cardiac specialist.
The overwhelming majority of people would forgo tax cuts to improve and defend their local health services. What message has my hon. Friend for the people who want a better Health Service, and not more tax cuts? How will he persuade the Government to take that message on board?

Mr. Cook: When my hon. Friend allows me to resume, I shall try to ram that message home. The point that he makes underlines the statement by the British Cardiac Society only last week that 10 million people are living in district health authorities with no cardiac specialists in the hospitals. We are told that the response to the problem—

Mr. Tony Favell: Will the hon. Gentleman give way?

Mr. Cook: No, I shall proceed with my speech if I may.

Mr. Favell: I want to take up a point that the hon. Gentleman has just made.

Mr. Cook: If the hon. Gentleman will bear with me, I am sure that he can aspire to catch your eye, Mr. Speaker.
We are told that the response to the problem is that expenditure must be more cost-effective, but the way in which we are managing our hospitals at present is ludicrously cost-ineffective. Whole operating theatres are standing idle because they cannot afford the marginal cost of operations. These may be cuts, but they are not savings. They represent waste on an extravagant scale: wasted investment, wasted technology and wasted skills. If we are going to bring those skills and investment back into use, we need extra resources.

Mr. Favell: Will the hon. Gentleman give way?

Mr. Cook: No, I shall not give way to the hon. Gentleman: I have made that perfectly clear to him. He is plainly not interested in hearing what I wish to say to him, and I therefore doubt very much whether he will listen to my reply.
For a moment last week, a light flickered. The Secretary of State met the three presidents, who emerged to say that he had discussed with them extra resources for the NHS. The very next day, the Chief Secretary puffed out that light: the Government would not budge from the commitment that they had made in the Autumn Statement.
The Secretary of State will know that, when he replies to this address, he will have to explain who has got it right. Was the Chief Secretary folded up in a corner of the office keeping notes while he met the three presidents, or were the three presidents right when they emerged to say that their fears had been allayed?
There is, of course, a weasel way out. The statement claims that there was a recognition of the need for extra resources. Perhaps the Secretary of State proposes to take the line that he recognises the need for extra resources, as long as they do not come from the Chancellor of the Exchequer. Let the money come from alternative funding, from income generation or from lotteries — anywhere but from the Government.
We now come to the interesting rhetorical body swerve that Conservative Members keep practising. Whenever they are pushed into a corner to admit the inadequacies of public funding, they start talking rapidly about private funding. But private funding of the NHS has nothing to do with value for money. The Government's handling of private pay beds has been a first-rate commercial disaster. They have increased private pay beds in our hospitals by a quarter, and, during the same period, the number of patients in those beds has fallen by one fifth. The total bad debts of the NHS from private patients has escalated every year, and now stands at £11 million—more than the Government anticipate that they will gain from income generation. In the light of that experience, only a Government who had smashed the learning curve could persist in the delusion that a financial problem can be solved with more pay beds.

Mr. Edward Leigh: Will the hon. Gentleman confirm that it is Labour party


policy to end pay beds at a cost of some £60 million and, incidentally, to end competitive tendering at a cost of £100 million? Does he agree that such dogma resulted in the pay of nurses falling for three years out of four under the Labour Government?

Mr. Cook: If the hon. Gentleman wishes to talk about dogma, let us consider dogma. Let us look at the instruction from the Minister of State to the West Midlands regional health authority that it can have £250,000 to buy private operations in private hospitals, but only to buy private operations and not to spend in its own hospitals. It is a sort of Health Service parallel to the assisted places scheme. On inquiring of BUPA, the health authority discovered that a hip replacement operation in a private hospital would cost £700 more than in its own hospitals and that a hysterectomy would cost £400 more.
Meanwhile, in Wolverhampton the regional health authority has so starved the district that it has closed the operating theatre for the orthopaedic ward. All hip replacements in Wolverhampton have ceased. To save what? To save a sum that is actually less than the amount that the Minister of State offered to the west midlands, earmarked for the purchase of orthopaedic operations in the private sector.
If the hon. Gentleman wants a little dogma, I can think of no clearer and finer illustration than paying over the odds to subsidise the private sector while forcing the closure of identical facilities in the NHS. That has nothing to do with cost-effectiveness but it has everything to do with political dogma.
That brings us to the heart of the debate between ourselves and those on the Government Benches. In truth, this is not a debate about public spending priorities; it is a debate about political values. The reason the NHS is under siege is that the Government's vision of a private enterprise society cannot tolerate the contradiction of a public health system that is more efficient and more comprehensive than its private sector competitor.
Those who sit on this side of the Chamber have the advantage of being able to see the Prime Minister's face, so we notice a revealing feature that may be lost on those who sit behind her. Whenever the Prime Minister recites the extra spending on the NHS under her Government, she does not do it with pride, satisfaction or relish; she does it with self-evident resentment. In her eyes, the NHS commits two fatal offences. The first is that everyone is equal, regardless of ability to pay. The second is even worse than the first: the service is actually popular because of that.
I do not know whether the right hon. Member for Brent, North (Sir R. Boyson) is with us today. The right hon. Gentleman has participated in exchanges on this subject outside the House. I particularly relished his speech on the fringe of the Conservative party conference last autumn, when he advocated an insurance system, with the Church of England catering for those who could not afford insurance. That does not seem an adequate solution for those who live in Scotland.
The right hon. Gentleman expressed the difference between our parties very well, I thought. He is on record as saying:
The problem with the National Health Service is that there is no link between what people pay and what they receive, and no way of influencing what they receive by what they are prepared to pay.

The right hon. Gentleman sees that as a problem. We see it as a strength of the NHS. Having glimpsed that gulf of political values between us, I think we can understand why the NHS is in financial crisis and why it will be kept in financial crisis. What we see as a crisis of the NHS some Conservative Members see as an opportunity to claim that the NHS cannot deliver and as an excuse to dismantle a service that they never liked. How else can we explain the persistent refusal to give it more funds, when we all know that the Chancellor's wallets are as ample as his presence?
That brings me to the third reason why it is important that the House debate the matter again. It is more than ever transparent that the Government can afford to fund the NHS. I note that The Times today quotes a Whitehall source as saying that the Secretary of State's argument will be
If you haven't got it, you cannot spend it.
Possibly the Whitehall source, who may be with us, would stand up and disclose himself so that we may see who is responsible for that wonderful observation.
The fact is that, in terms of financial resources, the Government have got the necessary funds. The Chancellor would need a JCB to cart the current Treasury surplus around Whitehall. Only today the Treasury, with impeccable timing, released the public sector borrowing requirement figures, which show that the PSBR is now a minus figure; that is Treasury language for being in surplus. There is a surplus of £400 million rather than a planned deficit of £4,000 million. Greenwell Montagu estimates that next year the surplus could be £11,000 million.
Perhaps I may dampen the enthusiasm of hon. Members on the Government Benches. Greenwell Montagu might not be spot on. Suppose it is wildly wrong. Suppose it is only half right. Suppose the surplus is only £5,000 million. That would still be enough to cut tax by the 2p beloved by the Chancellor and to give £2,000 million more to hospitals.
We saw on "Weekend World" that the Harris poll discovered that 68 per cent. of Conservative Back Benchers would rather see tax cuts than increased spending on the NHS. Those hon. Members need agonise no more. They can have both their passion for tax cuts, without any nagging doubts as to whether they are being faithful to the wards back home, and more expenditure o n the NHS. If Greenwell Montagu is more wrong and if there is only a quarter of that sum, there can be no serious doubt that if the Government have to choose, this year the priority must be not tax handouts but rescuing the NHS.

Mr. Robert McCrindle: rose—

Mr. Cook: No; I am moving to my conclusion.
If there is any doubt, may I conclude by reflecting on the people whose health and hopes are in our hands when we vote tonight? The most remarkable feature of the past year has been that tens of thousands of operations have been cancelled. No one knows how many, because no statistics are collected nationally. No one ever cancelled operations en masse before. We know that all districts have been postponing non-emergency operations until the next financial year. One district alone has cancelled 3,500 non-emergency operations.
Who are the patients who are non-emergency cases? They are patients in pain from hernias, patients going immobile from arthritis, patients who know that their hips


will deteriorate and that the operation will be more difficult when they get it, patients going blind—like the lady I met at the weekend who waited six months for the first examination for cataract, only to be told that she had another nine months to wait for the operation. They are patients with cancer, consumed with anxiety by the knowledge that the longer the operation is delayed, the less chance that it will be in time to be successful. There are also the parents whom my right hon. Friend the Leader of the Opposition and I met yesterday, driven to distraction by worry that the next time their child is called for operation it may be cancelled as it was last time.
Time after time in the last few months, consultants have said that it was not reasonable, fair or just that they be asked to decide who gets an operation and who does not, who dies and who lives. Ultimately we decide whether those patients will get their operations. It is our responsibility. This year the Chancellor of the Exchequer has the money to ensure that we get a National Health Service that can deliver to its patients. Tonight the House will have the opportunity to instruct him to make those patients his top priority.

The Secretary of State for Social Services (Mr. John Moore): I beg to move, to leave out from "House" to the end of the Question and add instead thereof:
applauds the achievement of the National Health Service in providing a record level of patient care; recognises that this achievement rests on the substantial additional funds from the taxpayer which a strong economy has made possible and which has supported the dedicated work of the National Health Service staff; and welcomes the Government's continued commitment to the most effective use of all the Service's growing resources to bring about a further rise in the standard of health care, both in hospitals and in the community".
May I start by genuinely thanking the hon. Member for Livingston (Mr. Cook), my "shadow", for his kind remarks with regard to my illness. He and I have known each other for many years and I am always conscious of his continuing courtesy and personal politeness, and I do appreciate it.
Having said that, I know that the House, as I think both I and the hon. Gentleman would wish it to, will treat a subject of this importance in the 40th anniversary year of the National Health Service with the serious, rational and thoughtful tone that it clearly needs. Health—or illness, as I certainly know to my personal cost—arouses deep emotion, but we will not find long-term solutions in emotion alone. It will require clear thinking. And above all—and I stress this in the light of the remarks that the hon. Gentleman finished with — it will require a successful economy.
May I start, therefore, with the fundamental point that good health needs and must have a successful economy. That has been the essence of the argument of the hon. Member for Livingston and of his right hon. and hon. Friends in the past few weeks. They have argued that the only answer—and they have put it in the motion in terms of a "financial crisis" — is essentially to spend more public money. They want more, that is, than the increases that we have provided and more than the increases we have promised. It is the only answer that they have offered. The awful, fascinating and terrifying thing

for them is that that is the only offer we know they cannot deliver if, ever again, we have the tragedy of having them in office.
I know full well and accept entirely, because they are not dishonourable men and women, that they do not mean to hurt the Health Service, and never intended to do so when they were last in office. But when the economy collapsed in their period of office, let me first remind the House of the priority they put on health care, and their attitude towards staff. I will come to the contrast with our attitude afterwards. Let me remind the House of the way in which they handled future investment in the NHS and their responsibilities when in office. First, public spending on the Health Service fell from 5 to 4·7 per cent. of GDP while they were in office.

Miss Marjorie Mowlam: Will the Minister clarify that health expenditure next year will fall as a percentage of GDP under this Government?

Mr. Moore: No, I will not. In a little while I shall explain precisely the increases, as the hon. Member for Livingston asked me to do. I shall also go beyond the GDP decline and specify them for the Leader of the Opposition when I come to comparisons with the Government's period of office. I shall specify the actual amount of money we are talking about, and deal with the way in which Labour treated Health Service staff. Opposition Members are concerned quite rightly about staff, because they are a key ingredient in the success of the Health Service.
Ancillary staff had their incomes reduced in real terms in the five years that Labour were in office by 4·8 per cent. Administrative and clerical staff had their incomes reduced in real terms by 14·4 per cent. For doctors and dentists, the decline was 22·4 per cent. in real terms. Nurses had their pay cut in real terms for three years running, and in 1976–77 by no less than 10 per cent. in real terms. In the five years to 1979, nurses had a reduction in pay of 21 per cent.
I shall come to the comparisons with our record in a moment. I said that there were three pillars on which I wanted to compare the record before going on to deal with patient care. The third of those is investment in the future. I and many of my right hon. and hon. Friends have sat in the House when investment in the capital of the National Health Service was slashed by 30 per cent. in real terms. Is this a record of which the Opposition are proud?
What is the contrast to that appalling record that they have the temerity to criticise in this Chamber? I stress again that because of our successful management of the economy we have a bigger GDP to help finance our health services. Let us examine our priorities, because that is the key question. First I shall deal with the percentage of GDP we have spent. I shall come then to the specific questions fairly asked by the hon. Member for Livingston in relation to his comments in the newspapers.
I remind the House that the GDP percentage declined from 5 to 4·7 under Socialism. What has happened since? It has increased from 4·7 per cent. and not to 5 per cent. but to 5·4 per cent. of GDP, so the percentage of a greater GDP has increased. That is why we are able to spend such enormous additional amounts of money. I am not yet dealing with the points made about pressures, but with the actual amounts of money, quoted time and again, the increase of 33 per cent. in real terms.
Just suppose for a moment that we had had the tragedy, with or without North sea oil, of having the Opposition


in office for the past eight and a half years, with the same increase in the size of the economy that we have achieved and 4·7 per cent. growth in GDP, which is the Opposition's chosen priority as a percentage. How much less would have been spent today, or in this year or last year? Spending would not have been £21 billion, but £18·1 billion. They would have spent £2·9 billion less, even with their own sense of priorities.
What about staff, who are treated so appallingly? I did say, Mr. Speaker, that before I dealt with staff I would cover the specific points made by the hon. Member for Livingston about what he thought was the difference between my views and those of my right hon. Friend the Chief Secretary to the Treasury. There is no difference at all; quite the reverse. People are able to do even basic calculations and consider matters post my party conference speech. Even though we now have the listening party sitting opposite, they do not necessarily spend their time listening to Conservative party conference speeches; but in my speech I made it quite clear that resources for the Health Service must increase.
What has happened since then? In the public expenditure round that was recently announced, there were the increases that had been planned before the general election, with £1·1 billion of further increases, which is £700 million more than had been planned. There were those increases, which I referred to in my meeting with the presidents of the royal colleges, and which were referred to by my right hon. Friend the Chief Secretary, and rightly, as the hon. Member for Livingston says, moneys that will come from the cost improvement programme and additional moneys that we hope will come from an increase in resources from the private sector.
Those figures have been tabulated, and we can consider the totals and calculate what has been spent in the past and what will go into health care next year. It might be of help to the House to know what they are. The total gross increase for 1988–89 in real terms will be 2·1 per cent. If we add to that the extra resources expected to come from CIP, that will be 3 per cent., which is far more than most of the Opposition have argued for. I am assuming those additions on the simple basis of the very good experience of the past few years.

Ms. Joan Ruddock: I should like to ask the Minister, despite what he is saying about increases, whether he can explain the paradox of my own local district health authority? As a result of the extra moneys that were given to maintain services, which I suggest is an admission of gross under-funding, those sums of money will enable us at the end of this month in theory to open closed wards. But we cannot employ the nurses to staff those wards and, indeed, we shall be forced to close wards again at the end of the financial year. Even the increases that the Secretary of State has announced for next year will not enable us to keep those services in existence.

Mr. Moore: Before I comment on the specific point, the hon. Member for Livingston would not, I know, want me simply to talk about the increases within the National Health Service as a whole, because he rightly tried to distinguish between the acute care hospital sector and the National Health Service, while acknowledging that there had been massive increases in real terms in the primary health care services. If one just looks at the HCHS and at

the total gross increase in the coming year, excluding the CIP programme expected yield, that will be an increase in real terms next year of 2·2 per cent., including the cost improvement programme at 3·4 per cent.
To be specific, the hon. Member for Lewisharn, Deptford (Ms. Ruddock) shares the dilemma of the RAWP disadvantage that many of us, including myself, who live within a Thames region have faced since 1977. Hon. Members who had experience and responsibility at the time will recognise the nature of the change, the reduction in the population and the problems associated with the Metropolis with regard to the attraction of' staff.

Several Hon. Members: rose—

Mr. Moore: I know that a very large number of Members wish to speak. I have given way so far and I would like to get on as I have quite a few things to say.

Mr. Favell: Is it not also the case that within the acute sector the performance of hospitals varies enormously? I draw my hon. Friend's attention to some figures recently published by the North-West regional health authority, which show that last year the cost of an in-patient case at Stepping Hill general hospital was £605·28, yet at north Manchester general hospital, where NUPE had recently been on strike, the cost per in-patient case was £1,107·33.

Mr. Moore: I am very grateful to my hon. Friend. I was planning to tackle that particular point later.
I was comparing the percentage of gross domestic product spent on health care. I then wanted to compare the appalling record of the Labour Government with my own Government's record in regard to improving the remuneration of staff. We have heard many times in the House, and I will not burden hon. Members by repeating them, the figures of staff increases, but I think it especially important to remind the House how those dealing directly with patients have increased as a proportion from 59 to 65 per cent.
In particular, I think that the record on the pay of nurses merits attention compared with the appalling record of the Opposition when in office. We have not simply established the proper pay arrangements through the pay review body; we are seeking to establish a pay arid grading structure for nurses and midwives which recognises the particular individual's skills and responsibilities. I know that all hon. Members will be particularly pleased that the Nursing and Midwifery Staffs Negotiating Council has reached agreement on the new grading definition, which has been sent to the review body.
The third point that I said I wanted to touch on was investment in the future of the National Health Service. The building of the new NHS from the appalling slashing of programmes that existed when we took office has been proceeding massively in the last eight years. As opposed to a reduction of 30 per cent., we have seen an increase, in real terms, of 40 per cent. We are now running a programme where we are spending £1,000 million a year on building the new NHS in the United Kingdom. All of this shows what can be achieved with a successful economy under our Government in contrast to the failure of the economy under Socialism.
I now want to illustrate, because I think that this is what many hon. Members would want me to do, what, at the end of the day, this means to patients. This, surely. is what we are all talking about. What these resources and the


enormous efforts that the National Health Service staff have put into improved efficiency, which must be recognised, have meant in terms of patient care is quite staggering. To describe the service as being on the point of collapse, in the light of these figures, is really appalling.
The achievements of the service, as my right hon. Friend the Prime Minister said last week—[Interruption.] I seem to have heard an interruption from a sedentary source asking why I did not use it. Happily, throughout my adult life, I have been able to benefit from the NHS, whether in Whittingham hospital, University College hospital or St. Thomas' hospital, and I am not sensitive in any way. I would assume that the listening party would like to listen to the end of these remarks.
Every member of my family has used and continues to use the NHS. I shall never forget the debt that I owe to the St. Helier hospital, where my mother died of cancer. I shall never forget the treatment that the doctors and nurses gave. But it is a bizarre feature of the world in which we now live that, because, as a consequence of my experience and knowledge, I was willing for many years, along with my wife, to pay less than I paid when I used to smoke as a modest contribution to the premiums of a non-profit-making organisation, when I chose this time not to burden the Health Service, not to force myself upon it, somehow it is regarded as wrong. That is one of the reasons why this country will never again elect the present Opposition to office.
Our great National Health Service deals with six inpatients for every five in 1978, 11 out-patients for every 10 in 1978—these are the realities for the constituents of Opposition Members—and nearly two day cases for every one in 1978. Those are the patients who are now receiving treatment in our acute care hospitals.

Mr. Robin Cook: rose—

Mr. Moore: I will continue for a little while, if I may.
There is not just more treatment, but better and more complex treatment. For example, many of us know that the first coronary heart bypass operation took place in the United Kingdom in the mid-60s. Three such operations are now being done for every one in 1978. Members of the Opposition do not want to hear the facts.

Mr. Cook: rose—

Mr. Moore: I will give way in a minute, when I have completed these figures because these are the figures of real patient care—[Interruption.]

Mr. Speaker: Order. Let us get back to the debate and the arguments, not personalise it.

Mr. Moore: Five treatments are being given for chronic renal failure for every two in 1978. Four hip replacements are being done compared with three in 1978. We are doing not only double the kidney transplants that we were doing in 1978, but more than any other European country. There were 30 bone marrow transplants in 1978; there is nearly one a day now. It is the Opposition, in the face of the reality of the great achievements of the National Health Service, who have lost their way. Finally, there were three heart transplants in 1979—in the whole year—but 176 in 1986, as well as 51 heart-lung transplants. Those are the figures of our NHS today.

Mr. Cook: If the Secretary of State is resting his case on the situation in our hospitals being so much better than it was under the Labour Government, can he explain to the House why during that Labour Government it was never necessary for the presidents of the royal colleges to go and see the then Secretary of State; it was never necessary for 1,000 consultants to go and see the Prime Minister; it was never necessary for general practitioners to pay for advertisements warning their patients what was happening to them; and it was never necessary for the BMA to set up a survey of acute specialties?

Mr. Moore: I will, of course, come to the way forward and the points on demography in a second but, since memories seem to be failing here, I will remind the hon. Member of what happened in 1978. On page 115 of Lord Donaghue's book, he said — and I believe that it is relevant—that in 1978
Mr. Callaghan again sought ways to justify providing extra funds to the National Health Service and asked David Ennals to produce a paper on the NHS crisis.
Beyond that, morale in the NHS was falling in March 1978. I can give chapter and verse and quote after quote. The British Medical Association chairman said that a big injection of money was necessary to resuscitate the NHS. Nurses said that
Lack of money prevents patient care
and that it led to the NHS crisis in August 1978. It is almost beyond belief for the Opposition to have the temerity not to remember the winter of discontent in 1978–79.
The statistics are not just bald statistics. They affect millions of families who have benefited each year from our hospitals and many patients whose quality of life has been improved by operations scarcely possible a decade ago. The hon. Member for Livingston asked why, despite this success story, the service is still under such pressure.

Mr. Kevin Barron: rose—

Mr. Moore: I wish to deal with this point. It is a legitimate matter to address.
Despite the increased efficiency and the increases that we have promised for the future, we must consider three factors before we can consider the way forward. We must see these factors as opportunities rather than problems. They relate to demography, to medical technology and its changes and to what some of my hon. Friends have been calling from a sedentary position the legitimate rising expectations of a more affluent society.
The picture is not unknown to most hon. Members who consider seriously the dilemmas that we face in western society. Happily, we are living longer. The over-75s have doubled since 1951. The over-80s will double by 2011. The implications for the National Health Service are enormous. As we grow older, demands on the Health Service increase disproportionately. When we realise that 54·6 per cent. of NHS beds are used by the over-65s the dimensions of the problem are better understood. Technology is not a problem, but an opportunity. I fully accept that point. The reality of increased patient care is a reflection of that.
The second feature of the inter-relationship of that change in demography is the total and wonderful change in medical technology which has enabled us to investigate, diagnose and treat conditions that would have been ignored or left dormant in the recent past. In addition to


that new technology, there are rising expectations about what the NHS can provide and legitimate changes in the consumerist attitude of an affluent Britain.

Mr. Barron: rose—

Mr. Moore: In an affluent Britain, consumers want more choice and expect to get the kind of choices that we are seeking to provide.
What, then, is the way forward? We must remember that the key to our policy must be a successful economy generating the wealth that allows us to continue the increases in resources that we have provided and promised, if we are to satisfy the legitimate public expectations of health care. I wish to concentrate on six matters beyond the basic improvement of the economy.

Mr. Barron: rose—

Mr. Moore: We must improve and enhance the service in the face of technology, demography and rising expectations. We must press on for greater efficiency. This is not simply a matter of being a good accountant. It is a matter of trying to use valuable resources in health care and nobody should want anything different.
We must acknowledge and give great credit to the Health Service for what it has already done in this matter. The cost improvement programmes have radically improved the way in which it can add money to health care. As a consequence of the cost improvement programme, £1·3 billion is now the cumulative addition to health care. We have streamlined the service by abolishing area health authorities and we have introduced general management which is beginning to produce major improvements. We have introduced competitive tendering which is saving £100 million a year, which will go into better patient care.

Mrs. Ann Clwyd: I notice that there is one comparison that the Minister has not made. Does he agree that every year, apart from one since the Government came to office in 1979, there has been a decrease in the amount of money spent on nurse training? It is the lack of quality nursing care which affects those who are waiting for hole in the heart operations. Can he explain why the Government have spent less money on nurse training since 1979?

Mr. Moore: It is critical that we address the point raised by the hon. Lady and the nature of the change in demography which has given us a smaller and different pool. It is part and parcel of the way in which we have approached the clinical grading review, about which I am delighted, and of the way in which we consider Project 2000. This is an area of critical training and is a key to the future. I know that the hon. Lady will be helping in this.
I wish to explain what has been achieved beyond the improvements in competitive tendering. There has been a better use of beds. I hate to use the terminology of the accountant—

Mr. Matthew Taylor: rose—

Mr. Moore: —but it is important to see the way in which the throughput of beds used has increased by 36 per cent. There has been a dramatic increase in day care. A vital part of this will be the provision of more and better information to doctors about the cost of the treatment that they provide and about the basis of our current resource management initiative.
Mention has already been made of the differences between authorities. When we are discussing the efficient use of resources, we must consider published indicators much more carefully. We now have 450 indicators. The system was established by my predecessor the Secretary of State for Employment in 1983–84 and was first published in the latter part of 1985. We are beginning to see clear benefits from it.

Mr. Matthew Taylor: rose—

Mr. Moore: If we consider the nature of the use of beds, the length of stay and the cost per case, the variations are still enormous. Even when we take into account the differences in the size of districts, geography, population and activity, these figures will help hon. Members to understand the nature of the efficiency gains. When we consider general surgery and the annual number of inpatient cases, the lowest figure of bed use given by one health authority runs at 27·8 per cent. and the highest figure runs at 70 per cent., so there is an enormous difference.

Mr. Matthew Taylor: rose—

Mr. Moore: Equally, the average length of stay of an in-patient in general surgery varies between three and a half days and 11 days.—[Interruption.] Unless we can secure the most efficient use of valuable resources, it is no good putting more resources into health care.

Mr. Nigel Spearing: Will the right hon. Gentleman give way on that point?

Mr. Moore: I know that hon. Members will be interested in the facts.
The cost per case — the third level — the annual revenue in-patient expenditure on major acute hospitals in the average district varies between a low of £467 and a high of £1,231. Those figures show the enormous opportunity for improvements.

Mr. Matthew Taylor: The right hon. Gentleman has well illustrated the increased throughput in beds and used it as an example of efficiency, but why have not we had the crucial statistic on the readmission of patients who have been pushed out of hospital and who have had to be readmitted? For example, only a few days ago a constituent of mine, having rescued people from a burning house and been admitted to hospital after he collapsed, was discharged at 3.30 am and had to walk 20 miles home.

Mr. Moore: I shall ask my right hon. Friend the Minister for Health to pursue that constituency case, but at the end of the day in every case the removal of people from hospital is a matter for clinical judgment, not for the Government.

Mr. Michael Morris: My right hon. Friend has rightly given some conclusive statistics. Will he take heart from the fact that year in, year out the Public Accounts Committee looks at the NHS and reports that there is further work to be done in those areas?

Mr. Moore: I thank my hon. Friend who has given many years of distinguished service on the Public Accounts Committee.
I said that there were six areas I wanted to pursue as part of the way forward. The second, beyond trying to achieve major efficiency gains, is to encourage health authorities to take full advantage of the income generation


powers contained in the Health and Medicines Bill which is now being discussed in Committee. Those are not insignificant amounts of money. At least £70 million a year could be generated and my Department will shortly set up a special unit to encourage and help health authorities to pursue this initiative.
Thirdly, I want to encourage health authorities to use — this is critical and I know that many of my hon. Friends share our view — spare capacity in other authorities whenever it is sensible and cost-effective to do so. That is already happening in part under the waiting list initiative. I want to encourage it, to improve the accounting information systems and to give patients a better knowledge of the system through giving better information to general practitioners.

Mr. Barron: rose—

Mr. Moore: I have given way frequently and I think that it would assist the House if I were to move forward.
Fourthly— this is important—I want to seek to increase the total resources going into health care by encouraging further co-operation with the private sector. I shall not allow narow-minded dogma to stop resources being used for patient care. One of the great weaknesses of Britain's Health Service is the small contribution made by the private sector compared with that in other countries.

Mr. Barron: rose—

Mr. Moore: In France, 2·7 per cent. of GDP goes into health care from the private sector, in Germany 1·8 per cent., in Canada 2·1 per cent., and in Holland 1·9 per cent., compared with only 0·5 per cent. in the United Kingdom. There is a clear gap there. We must seek to encourage such contributions.

Mr. Barron: rose—

Mr. Moore: Fifthly, we shall improve the primary care services. The hon. Member for Livingston has recognised the major increases in real resources in those in the past eight years. They are critical to our acute care hospital service because they are the gateway to the expensive hospital sector. The announcements in our White Paper about the way in which we are seeking to amend general practitioners' terms of service to clarify their role in the provision of health promotion services and the prevention of ill health are critical. Equally, we want to introduce a range of incentives through general practitioners' pay to encourage them to carry out specific activities such as attaining target levels of vaccination and screening. That has been welcomed by most hon. Members.
Sixthly — this is also important and surrounds the debate outside as well as inside the House—I want us to focus much more on the overall objective of our health care policies. Our aim is clear—better health for the nation. So much of today's debate has been trapped on inputs—money, staff and beds. I accept that those are important, but we look too little at the outcome or the outputs. We need better indicators and targets to help us to judge good health against which we can judge our inputs and objectives.

Dr. David Owen: I, like other hon. Members, have listened for a sign of any new policy or hope. Will the Secretary of State at least say that, if the

independent review body on nurses' pay makes, as everyone hopes, a substantial recommendation over and above that allowed for in the Government's public expenditure White Paper, that settlement will be met in full by the Government, as happened in election year? That reassurance is genuinely needed.

Mr. Moore: It is the height of cheek for a right hon. Member who supported a Government with an appalling record on nurses' pay to make such a comment. The Government's record on the nurses, the setting up of the pay review body and the way in which its reports have been implemented is second to none.

Mr. Neil Kinnock: Will the Secretary of State now answer the question posed by the right hon. Member for Plymouth, Devonport (Dr. Owen) which I have addressed before? Will the Government fully fund the next pay increase for the nurses? If they do, it will be the first time.

Mr. Moore: First, that is factually inaccurate. The Government fully funded —[Interruption.] Not all. The Government's record on the nurses, as the right hon. Gentleman knows to his discomfort, is outstanding. [HON. MEMBERS: "Answer the question."] I am trying to do so, despite the sedentary interruptions.
If the right hon. Gentleman ever stood on this side of the Dispatch Box —I hope that that will never occur —I am sure that he would not submit to the pay review body not only recommendations but the assumption in advance that full funding would automatically occur. That would not be a recipe for serious debate about serious work and serious attempts to achieve proper incentives to efficiency within the service. It would be foolish to do so.

Mr. Kinnock: The word that the right hon. Gentleman is groping for is "no".

Mr. Moore: No, I am groping for one thing only—the Government's responsibility and record.

Mr. Barron: rose—

Mr. Speaker: Order. The hon. Gentleman must not keep rising. The Minister has already given way to the Leader of the Opposition.

Mr. Moore: All the measures that I have outlined are sensible and deserve the support of everyone who cares about the nation's health. I am glad that we are having this debate today and I welcome the wider debate that is taking place in the country on the future of the NHS. It is right that the whole nation should be involved in constructive discussion about health care. What is wrong is when the discussion degenerates into destructive attacks upon the Health Service.
The National Health Service enters its 40th year with a proud record. It is wilfully blind not to recognise its splendid achievements—in particular, those of the past eight years. Worse than that, attacks on the service damage the morale of workers in it and undermine the confidence of the public. However, the NHS also enters its 40th year facing unprecedented demands. That is why it is so crucial that our debates are informed and rational. Fevered attacks will not help the National Health Service. We stand firmly — I think the hon. Member for Livingston wanted me to say this, and I shall be delighted to do so—as we always have, behind the principle of the NHS, which is that adequate health care should be


available to everyone no matter what his means. At the same time, the dramatic changes in demography, technology and expectations that I have outlined today mean that we must constantly reconsider how that principle can best be implemented.
The Government have increased the resources that are available to the National Health Service every single year since they came to office. Those increases will continue, but, in the light of the accelerating and unending demand for health care, we must consider even more carefully how resources can best be used and how, like other western countries, we can encourage a greater private sector contribution to enhance and add to the increasing resources that the Government have already committed.
Today, thanks to the Government's excellent record, health care in this country is being provided for more people by more skilled staff in better facilities than at any time in our history. We shall build on these achievements in meeting the challenges of tomorrow. It is in that spirit that I look forward to the contributions of hon. Members to the debate, and in that spirit that I urge the House to reject the Opposition motion.

Mr. Stanley Orme: The Secretary of State has not answered the central question why the National Health Service is in the biggest crisis since its creation in 1948. Why are hospital beds and wards closing? Why are people having to wait longer for treatment? Why is there a shortage of nurses now?
The Secretary of State referred to the period of the Labour Government. In Salford, part of which I have represented for the past 23 years, we have never known such a crisis. Under the Labour Government we were building a hospital; under this Government we are closing hospitals. Why has the whole country suddenly reached this crisis? It is to be found not only in the inner cities, but everywhere. The basic problem is that since 1981 health authorities have had to face the cuts that the Government have imposed. If there was any fat to cut out before, there is none now, so the authorities are up against it.
Let me discuss my inner-city area. We heard much from the Government after the election. We heard from the Prime Minister that priority was going to be given to inner-city areas. Some of my hon. Friends, like myself, represent inner-city areas. Salford has a large elderly population suffering from chronic medical problems. As a result, my health authority will have to cut £2 million a year right into the 1990s. If the Government make that happen, it will mean that four wards will have to close in one hospital; in another, a children's hospital, two will have to close. Salford royal hospital, a nationally known hospital with a great reputation in the medical world, is now threatened with closure.

Dame Elaine Kellett-Bowman: Does the right hon. Gentleman know that his authority has the second highest administrative costs in the country? Will it now save something in administration rather than close wards?

Mr. Orme: Our costs are high because demand is high in our city. We are very efficient, and I want to quote to the hon. Lady what professor Galasko, operating at the Hope hospital in Salford, has to say:
The service we give is not ideal, but it is of such a standard that complex cases continue to be referred to our Department

in ever increasing numbers. For example, the numbers of patients on my own Waiting List have increased from 219 in April 1986 to 291 now. The waiting time for surgery has also increased. The waiting time for adults on my Waiting List has increased from 51 weeks in April 1986 to 107 now, whereas the waiting time for children with complex orthopaedic problems has increased from 82 weeks in April 1986 to 102 weeks now.
That is the position in my health authority. The Ladywell unit, a special unit for young disabled people, of which we are proud, is threatened with closure. What does the Secretary of State have to say about that? What does he have to say to the young people I have seen there, for whom it is a lifeline? They are seriously disabled young people in their teens and early twenties and thirties. What chance have they when the unit is threatened with closure?
Only last week, a nurse from the Royal Manchester children's hospital made a statement. Sister Margaret Rickard said:
No one else will say this. I have been waiting too long for it to be said—now I am going to say it.
A lot of these children arc desperately ill. I am sure very ill kids are going to die because there is nowhere for them to be seen.
That is what is happening in a hospital in the constituency of my hon. Friend the Member for Eccles (Miss Lestor).
Throughout the country, from one area health authority to another, the story is the same. The Government must answer these charges. But what do we get from the Secretary of State today? He is making no promises of new resources, nothing concrete for the nurses and no method of dealing with the problem. He talked about 1978 and 1979, but I have never known the medical profession so united and agitated as it is now. Doctors, local medical committees, surgeons, orthopaedic surgeons, nurses and nursing ancillaries are all saying the same thing. They are talking not about what might happen, but about what is happening now. Wards are closing and people cannot obtain services. From the consultants to the trade unionists, the message is the same.
Prestwich hospital is under threat, and the unions are fighting that. What proposal has been put forward to assist with that? Bio-Plan Holdings Ltd. has come forward to say that it will put some tin-pot private development on a National Health Service property. It says that it may treat National Health Service patients at cost plus 10 per cent.
There is no answer to the problem of the National Health Service. The National Health Service was created so that people could use it at a time of need and pay for it throughout their working lives. That is the basic philosophy. If we move away from that, we shall go clown the American road of different standards between those who can afford to pay and those who cannot. We shall have National Health Service hospitals, but people will have to wait 12 months, 18 months, or two years before they get any service at all.

Mr. Terry Lewis: My right hon. Friend spoke about possible ward closures at Pendlebury children's hospital. Is he aware that on the other side of my constituency the Astley hospital is under threat of closure? This morning, I learnt that two ambulance stations are threatened with closure. The area has already had cuts in the number of ambulances, but now there is the possible closure not only of emergency services, but of ambulance stations.

Mr. Orme: It is all cumulative. Wards are being closed. Waiting lists are increasing and hospitals are under threat. I am talking not about Britain, but about Salford. Many of my hon. Friends can give similar examples; and if Conservative Members had had the honesty to do so, they, too, could give similar examples.
The National Health Service needs to be rescued. The money is there. As my hon. Friend the Member for Livingston (Mr. Cook) said, money can be injected. Instead of money coming from the contingency fund on a one-off basis, which might suit the right hon. Member for Chingford (Mr. Tebbit), Opposition Members want the funding which is available now to be used for tax cuts to be given instead to the National Health Service in order to give it a new lease of life. We could then consider the matters about which the Secretary of State was speaking.
First and foremost, we must save the National Health Service. That is the battle in which we are engaged. For the first time in my political life, all the forces in the National Health Service are united in that battle. That is the message that we give to the House and to the Secretary of State. The British people want action, and they will demand it.

Mr. Norman Tebbit: I hope to be brief to allow other hon. Members to speak. First, I should declare an interest in that at least one of the companies in which I am involved may in future act as a contractor to the National Health Service. I am glad about that, as I believe that it will benefit the company and the Health Service.
The speeches of the right hon. Member for Salford, East (Mr. Orme) and of the hon. Member for Livingston (Mr. Cook) were interesting in that they were extremely long on complaints but short on cures. The hon. Member for Livingston was short on answers. He certainly could not answer the crisp and pointed question put to him by my hon. Friend the Member for Mid-Worcestershire (Mr. Forth).
Implicit throughout the debate has been the acknowledgment that, because of the success of the Government's policies which had always been opposed by Opposition Members, the Chancellor can make available, they say, extra resources which no Labour Government could have provided. It was not a lack of North sea oil that forced Chancellor Healey to go to the IMF with his troubled economy and to slash the Health Service, cut nurses' wages in real terms, close hospitals and lead us into the winter of discontent when almost every hospital in the country was closed.
I welcome the opportunity for a debate —[Interruption.] I see that the hon. Member for Liverpool, Walton (Mr. Heifer) is debating in his usual style with loud remarks made from a sedentary position.

Mr. Eric S. Heffer: rose—

Madam Deputy Speaker (Miss Betty Boothroyd): Order. I do not believe that the right hon. Gentleman is giving way. Is that the case?

Mr. Tebbit: That is quite correct.

Mr. Heffer: rose—

Madam Deputy Speaker: Order The right hon. Gentleman is not giving way.

Mr. Heffer: The right hon. Gentleman referred to me.

Madam Deputy Speaker: Order. Is the right hon. Gentleman giving way?

Mr. Tebbit: No. [Interruption.] All those who know the hon. Member will know the truth about that.
I should like to express my great thanks to Mr. Maxwell and to the Daily Mirror for all that they have done to precipitate the debate. But for the Daily Mirror and others, we might have drifted on without having a proper debate on these issues. Now, if we are to have a debate, let us have an open debate and try to reach some conclusions.
Last Friday, I posed some questions about the National Health Service, and I should like to enlarge a little on those questions. Some of them were inherent in the question put by my hon. Friend the Member for Mid-Worcestershire, which the hon. Member for Livingston could not answer. The House should turn its mind to the question whether there should be any limit on National Health Service expenditure. The hon. Member for Livingston looks puzzled, but he must understand the question—I hope that he understands the question.
Should expenditure be entirely demand-led? We must think of the implications of allowing the Health Service the privilege of demand-led expenditure, which would give the Health Service the right either to unlimited taxation or to require unlimited cuts in other expenditure programmes. [Interruption.] My hon. Friend the Member for Birmingham, Selly Oak (Mr. Beaumont-Dark) says that nobody has asked for that. But it was implied in the speech of the hon. Member for Livingston that the Opposition would deliver it.
I should like to know whether the Opposition favour an absolute limit on Health Service expenditure, or whether they favour a demand-led expenditure. When we have an answer to that question, it would be wise to ask what that limit should be and how it should be expressed. Should we continue to express it as we do now, in public expenditure White Paper money terms, after the Star Chamber and all the trials which Ministers have to go through, or should we express it as a percentage of GDP?
My right hon. Friend rightly took pride in the fact that we have increased the share of GDP going into the National Health Service. Should we set a target or a limit in those terms? That would be a buoyant limit of revenue — unless we had a Labour Government, when GDP would fall and there would be the usual cuts. Should it be a slice of revenue or a percentage of income tax, the product of 15p off the standard rate of income tax which it currently requires, or the product of a rate of VAT, recollecting that the Health Service costs just about all the revenue at present achieved from VAT? Those questions are worth asking and worth answering.
Then we should go on to ask how that cash should he raised.

Mr. Tony Lloyd: I follow the drift of the right hon. Gentleman's questions, which will strike a chord with Conservative Members. If he is seeking a more rational way to distribute health care, he would not support the local authority in central Manchester which is talking about voluntary or compulsory redundancies. That is irrational.

Mr. Tebbit: It is clear that I was unwise to give way to the hon. Member for Stretford (Mr. Lloyd), who wanted to make a complaint instead of contributing to the debate.
We should then ask how that cash should be raised. Should it continue to be raised almost exclusively from the general burden of taxation out of the Consolidated Fund, or should we look for other methods of raising money? Should we look to the example of West Germany where the service is funded by a payroll tax—

Ms. Harriet Harman: No.

Mr. Tebbit: The hon. Lady immediately says no, but she has not even thought about it before reacting. The listening party is leaping to conclusions.
Should we give consideration to a payroll tax for health purposes, as in West Germany, where the current payroll tax is 12 per cent. and has been judged to be too high? Efforts are being made to reduce it because the burden is too heavy. Should we go down that path, or should we denominate some part of income tax? The Chancellor would never agree to a hypothecated tax, but a quasi-tax such as a payroll tax or a slice of VAT may be possible. We should be debating those questions, instead of the shroud-waving exercise which has been going on exclusively for the local press of Opposition Members.
We should look at how we provide the service. We cannot doubt all the statistics, but I will come now to some that I do doubt. The increase of almost one third in real terms, which has been put into the Health Service in cash, the 64,000 more nurses, the 13,000 more doctors and dentists—where are they? When my right hon. Friend the Minister referred to resources, Opposition Members posed an important question, which the hon. Member for Livingston (Mr. Cook) has not really thought about yet: "Then where has it all gone?" That is a very good question.
Are those nurses standing beside beds and are the doctors standing alongside them, or have they gone into a vast administrative black hole? We hear much about the cancellation of health care due to a lack of nurses or medical equipment, but I have never heard of a committee being cancelled because of a lack of photocopiers, paper or clerks to push the paper around. I sometimes wonder who sets the priorities within the great bureaucracy of the National Health Service.

Mr. Nigel Griffiths: The right hon. Gentleman implies that nothing has been done for the past eight or nine years. What have his Government been doing about it?

Mr. Tebbit: The hon. Gentleman asks a fair question. We have had Health Service reorganisations under various Governments, all within the context of the nationalised provision of service, and none of them has been outstandingly unsuccessful, perhaps because of the very nature of the provision. The listening party, in a leaflet distributed over the signature of the Leader of the Opposition, asks that question. The Leader of the Opposition says that we should ask whether the way we provide health care is the best way. I do not know whether that is a genuine question or he has already closed his mind on the issue, but we should have open minds on it. I hope that the hon. Gentleman will join me in having an open mind on it and will consider it on its merits.
I dealt earlier with the point raised by the hon. Member for Livingston about my remarks on nurses who work extra time for extra money. I recognise that many nurses work overtime without being paid, but if they work overtime they ought to be paid. My criticism of the system

is that it precludes them from being paid for working overtime in their own hospitals, but provides for them to work overtime in other hospitals. That seems to be administrative nonsense.
As a London Member, I recognise that the differential between the pay of nurses and others, and between the London rate and the rate in areas where the cost of living is much lower, is too narrow. If I recollect rightly, that was part of the burden of the Government's evidence to the pay review body, which unfortunately was not accepted or acted upon by that body. It is no wonder that medical staff, particularly junior nurses in London, look for other sources of pay, because they find it extremely difficult to afford accommodation unless they can increase their pay. My criticism is overwhelmingly of management and the system.
The Health Service is not just people, although people are the most important part of it. Capital—cash, money —is another part of it. I take issue with the reliance that is sometimes put on some statistics, as to which hospital is cheaper or more expensive than another for an operation because, typical of a nationalised system, there is no balance sheet and capital comes free. Nobody accounts for the cost of capital. Once the investment is made, it is written off. Nobody thinks of putting a cost on the money which must be provided so that the comparisons may be not about the efficient way a hospital is managed but about which hospital has had a huge injection of capital and which has not. The nationalised system has inherent defects, which mean that capital is not properly allocated. All too often it goes in not on the basis of need but on the basis of decibels of squeal, and we have no real idea whether the capital is being effectively and efficiently used.
That leads me to the question posed by the hon. Member for Edinburgh, South (Mr. Griffiths) and by the Leader of the Opposition—although he is not seriously interested in the answer—has hospital nationalisation been a success? We would be unwise to leap to the conclusion that it has. Is the present system likely to use scarce resources of cash or staff effectively? We should not leap to conclusions; there is time for mature consideration and to do a proper job. We must do our figures carefully, taking into account the cost of capital.
The right hon. Member for Salford, East compared the cost of the public and private sectors in his city. Is the public sector expected to remunerate its capital? Of course not, but the private sector is, so we are not comparing like with like. If capital is free, it is likely to be badly used, and if we do not account efficiently for the cost of it, how can the people in the Health Service know whether they are doing well or badly?
I end with two points: the essence of the Health Service, as my right hon. Friend the Minister said, is that treatment should be available regardless of ability to pay. It is not essential to the Health Service that provision should be made exclusively through either the public or private sector, or that the funds to finance it should come exclusively through the tax system, or exclusively or partially through charges for service at the time of provision.
I have supported the huge increases in national health spending under this Government, and I am glad that expenditure will continue to increase, but I say to my right hon. and hon. Friends that I would strongly object to a


policy of drip-feeding £100 million by £100 million, or even £1 billion by £1 billion, to those who complain the loudest.
No doubt if my right hon. Friend the Chancellor were to decide that there are to be no tax cuts, no attempt to reduce public sector borrowing, which he should do—preferably he should have a negative PSBR next year—if he spent the whole amount available on the Health Service, it would not be many years before the demand would rise again, with people saying, "We want more." The more money that is drip-fed in response to complaints which are not always—I emphasis not always—quite rational, the worse the service will become, because it is not an efficient allocation and use of resources. We should seize our chance and re-examine the whole funding and provision of the Health Service and should make that searching review a condition of any more funding. The best comment yet was the sedentary question posed from the Opposition Benches: "Where has it all gone then?" That is what we ought to know before we decide to put any more into the same system.

Mrs. Rosie Barnes: We have heard much in recent weeks, and today in the House and in the country at large, about the crisis in the Health Service. We have heard continually from the Government that there is no crisis. Today has been no different.
There is nothing new and no hope or enlightenment for people on waiting lists. Statistical answers bring little comfort to people who do not know whether their children will live long enough to have vital operations.
I agree with some of the sentiments that have been expressed by Conservative Members. We must reconsider this problem and open a debate on the state of the Health Service, what it will provide and how we shall fund it.
The Government cannot continue to pretend that there is no crisis, when the country is screaming that there is. Short-term and panic-stricken cash injections and mindless repetition of statistics are not the answer. Equally, it is quite wrong to pretend that an infinite demand for health care can be instantly financed out of the public purse.
There is an important issue that we must face as a country. We should be looking for a consensus and we should put party politics behind us. We must acknowledge the changing circumstances in which the National Health Service makes its decisions. We must acknowledge the increase in the number of elderly people and the demands that they will put on the Health Service. We must acknowledge the fact that technical advances, in many respects, are making the Health Service a victim of its own success.
There is no point in developing new technology if ordinary people do not have access to it. We need longterm answers on which we can all agree. There is no greater sector of need for a national consensus than funding of the National Health Service. Yes, we need a debate, but not only on the expenditure involved or the limits of expenditure; society must make decisions on what level of health service will be provided and how it will be paid for.
What criterion of assessment should we use? It is simple: if it is available, I want it for my family. The rest of the community feels the same. There should be a

guarantee of treatment, if it is available, within a reasonable period of time. Patients have rights. Desperate recourse to courts by distraught parents is an indictment of our society.

Mr. Tebbit: What the hon. Lady is saying is in slight conflict with what she said earlier. If she is saying that a treatment—that is, if it exists—should be available when people want it and that they should have it regardless, she is saying that there should be a demand-led service with no financial limit. Which side of the question does she come down on?

Mrs. Barnes: I am saying that society must consider this question and come up with the answer. If treatment is available, I would apply the criterion that people expect their family to be treated; if it is available privately, it should be available on the National Health Service. We must look, as a society, at how we shall pay for this service, and we must take that question very seriously.

Dame Elaine Kellett-Bowman: The hon. Lady's exact words—she can check them in Hansard—were:
There should be a guarantee of treatment … within a reasonable period of time.
That rather answers the question that my right hon. Friend the Member for Chingford (Mr. Tebbit) asked.

Mrs. Barnes: I believe that there should be a guarantee of treatment within a reasonable time.
What is needed is a consensus and answers that will last for some time to come. That consensus should be based on three elements.

Mr. Keith Raffan: Will the hon. Lady give way?

Mrs. Barnes: No, I shall not give way.
First, there should be increased Government spending in line with growth in GDP. Earlier, the Minister spoke of the importance of the economy and its relationship to the nation's health. There is no direct relationship, but a significant link can be made if a specific portion of the national economic cake is allocated to the Health Service.
Secondly, we must find ways in which to encourage people, individually, to spend more on health care without abandoning the principles of the National Health Service — for example, through rededicating premium bonds and through local health lotteries. There is considerable evidence that people are prepared to spend more indirectly if they know that the money that they are giving is going straight to the Health Service and not being absorbed in general income.
Thirdly, we must realise that we can use existing resources even more efficiently by creating an internal market that matches the internal supply and demand of individual health authorities in a much more effective way. Clearly, if people needing treatment would receive it far more quickly in a different health authority there is no reason why they should not be given the right to take advantage of that authority's facilities and their own health authority should have to pay the bill.
I should like to highlight one less-emphasised but equally important crisis in the Health Service—the crisis caused by the implementation, not the principle, of the Resource Allocation Working Party proposals. The problem is the lack of funding caused by the implementation of those proposals in certain parts of the country.

Ms. Joan Walley: I should like to point out to the House that there is a myth in this country and in the Chamber that other parts of the country are benefiting from RAWP. In my constituency, the North Staffordshire district health authority is not receiving the benefits of the special deprivation programme. It has been suspended by the Government because of their failure to meet the nurses' pay increase in full.

Mrs. Barnes: I shall refer to the shortfall in some areas in that regard—but in some areas only.
I am completely committed to the principle of reallocating resources from richer health authorities to poorer ones. It is of great concern to us all that people's chances of avoiding serious illness or premature death depend far more than in comparable countries on the social class to which they belong or the area in which they live or were born.
I am concerned about the way in which the RAWP formula is being implemented. It does not take adequate account of social deprivation at regional or sub-regional level. By and large, RAWP overlooks what can be substantial pockets of deprivation in large regions such as the south-east, which generally is wealthier and better provided for than other areas. The result is that many inner-city areas, such as Greenwich, which have a high need for health care because of considerable social deprivation, do not receive the resources they need because RAWP, in terms of South East Thames regional health authority, and sub-regional RAWP, in terms of Greenwich, do not take adequate account of social deprivation, poor housing and low income, which undoubtedly contribute substantially to poor health. The assumption was that, in such areas, there would be substantial cuts in provision.
In my area, it was expected that the demand for acute hospital beds would fall, so the health authority made provision for such a reduction. The exact opposite has occurred, and demand for those beds has substantially risen. The assumptions contained in RAWP may have been true across the board, but in significant patches those assumptions have proved false. That has caused significant hardship to health authorities, and especially for patients in those areas.
I want a RAWP formula that accurately reflects the need for health care at regional and sub-regional level. What matters is how many people in a given area suffer from ill-health and therefore require care. Some of the evidence used to assess health care has been inaccurate. There has been a tendency to rely heavily on standard mortality rates. There is also a clear suggestion that, in areas of social deprivation, chronic illness is far more persistent and far more widespread. Such illness may not be fatal, but it needs treatment.
To rely solely on standard mortality rates is not enough. There are measures afoot to try to reconsider the RAWP allocations to take account of social deprivation. It has been suggested that the ACORN technique should be used to take account of such deprivation. However, that technique has aroused considerable anxieties because it was intended as a marketing tool and not as a measure of the need for health care. ACORN also uses information based on the 1981 census and, in the inner-city areas, that census material is considerably out of date and does not reflect the current position.
The practical effects of the loss of income in certain areas as a result of RAWP have been severe. In my area, we have lost three hospitals and are faced with the prospect of losing two more. Indeed, many of the areas affected by RAWP were not designed to cater for the medical needs of the 1980s and 1990s. Such areas have many small cottage hospitals — perhaps one large hospital— but do not have adequate facilities to cater for the needs of the community. The closure of five hospitals will entail substantial expensive changes. Such changes can be ill afforded and, in the light of severe cash shortages, are poorly carried out. The problems connected with RAWP allocation are the clearest illustration of the paucity of the Government's approach in specific areas.
The Secretary of State constantly tell us that the NHS has never had so much money devoted to it and that all is well, but people are feeling the pinch. They are experiencing hospital and ward closures and long waiting lists. They know that it is a very different story. The perception gap between the people and their Government is breathtaking.
District health authorities' problems have been compounded by the Government's refusal to fund nurses' pay awards in full. The Government cannot continue to evade their responsibilities by only partly funding pay awards and expecting health authorities to make savings to achieve these awards. Such authorities are already under considerable financial pressure.
It is clear that there is no room to make further cost savings. Perhaps there was some fat to be trimmed, but now we are down to the bone. Any further pay increases must be funded in full by the Government. It is clear that some RAWP money that had been reallocated and money that was intended to prioritise certain areas of health care is now used as basic revenue. There is little point in the Government encouraging health authorities to prioritise certain areas of health care or to reallocate resources to areas of greater need if the money provided to achieve those aims is used to provide the basic facilities.
I believe that we should have a national debate and a review of what we expect from our Health Service and how we are to fund it. We also need to consider the subsidiary issues of how we can be sure that the aims of RAWP are fairly realised so that broadly economically successful health authorities, which contain within their larger areas pockets of social deprivation, are not penalised.

Sir Barney Hayhoe: In the November debate I began my speech by regretting the absence of my right hon. Friend the Secretary of State and I hoped that he would soon be fully restored to health. I am delighted that he is now back and that he will be participating in our continuing debates.
I welcome this wide-ranging debate about the NHS and health care. The debate has been raging with great intensity since we last spoke about these matters in the House. However, I deeply deplore the sharply personalised turn that has been taken in the public expression of this debate in the past few days. My right hon. Friend the Secretary of State has been targeted as some sort of fall guy. It would be wholly inappropriate for my right hon. Friend the Secretary of State for Employment to claim credit for the steady and welcome reduction in the numbers of unemployed that he is now able to announce to the country each month. Equally it would be wrong for


my right hon. Friend the Secretary of State for Social Services to be blamed or held responsible for the financial difficulties now facing the hospitals and community health service.
I agree with my right hon. Friend that there are serious problems deserving rational and well-informed debate. It is right to state — as my right hon. Friend did on a number of occasions during his speech — that a successful economy and sensible economic policies that provide national wealth are absolute requisites to provide money that can be spent on the Health Service and other desirable social objectives and to improve the general standard of living. However, highly emotive questions traded for repeated, well-used statistics — however impressive the statistics — make little contribution to solving the problems.
In November I said that the statistics must be considered carefully. My right hon. Friend the Member for Chingford (Mr. Tebbit) has referred to the number of nurses and asked where they have all gone. What is interesting is to consider when those nurses arrived. The annual report on the Health Service in England published a few days ago shows that there are some 403,000 whole-time equivalent people in nursing and midwifery in England. Since 1979 the number employed has increased substantially, by 44,000. It is clear from the figures that an increase of 38,700 took place before the 1983 general election.
At that election we rightly took great credit for those extra nurses and midwives. However, in the four years since then the increase has been only 5,600. The increase has flattened off. Equally, while substantial extra sums have been spent on the Health Service, the really sharp increases took place in the early years of the Conservative Government and were largely used to restore the pay of National Health Service staff to some sort of reasonable standard from the low level to which it has sunk, leading in part to the winter of discontent of 1978–79.

Mr. Robert B. Jones: I am most interested in the points that my right hon. Friend makes. However, is it not fair to note that comparable countries can manage with half as many nurses per bed or per head of the population and that our nurses are doing jobs that might well be done by far less well qualified people in other countries? Is not that point worthy of attention?

Sir Barney Hayhoe: My hon. Friend assumes that nurses in this country have the same qualifications as those abroad. They do not. In other countries, nursing is largely a graduate profession. We may be moving towards a graduate profession, but the process will not be completed for many years to come. Over-simplified international comparisons do not really help the debate. One needs to be sure that one is comparing like with like. I certainly do not believe that we are getting particularly poor value for the money that we spend on the National Health Service.
Let me deal with two or three of the major events that have taken place since our debate last November. First, the Government have come forward with an extra £100 million to meet specific urgent requirements in the present financial year. I welcome the decision to add that extra money from the contingency fund.
We have also witnessed a series of strikes and disruptive action by some nurses—not by the Royal College of

Nursing, I hasten to add, but by other unions. I do not know all the facts, but I question the Government's reaction to those strikes or at least the way in which it has been perceived by the press. The phrase "Government climbdown" is often used. That seems to me to be a highly dangerous message. It is dangerous for it to be thought that the Government are responding in that way to militant and sometimes irresponsible action by the trade unions responsible for some National Health Service staff. Certainly, the anti-privatisation strikes in Scotland are wholly unjustified. Of course there should be competitive tendering and the money available should be used in the best possible way.
The £100 million extra is very welcome, but it seems to have been dragged out of a reluctant Treasury. How different the scene would have been if that sum had been announced in the wind-up of the debate on 26 November. One of our problems as a Government is that we have spent this additional money in such a way as to get little praise for it. Delay has strengthened the arm of the Treasury, which will say to the spending Ministers, "Look. We agreed to that extra money but instead of plaudits we are attacked." And this because the announcement had been so long delayed. For heaven's sake, when we make extra resources available—and I believe that we must continue to do so—let us draw credit from it and ensure that it is to the Government's advantage.
The bulk of that extra money will help with the serious over-spending problems that confront so many district health authorities, which stem largely from the underfunding of pay increases made as a result of pay review body awards, or negotiations through the Whitley system in the case of non-pay review body staff. Tremendous difficulties are caused when pay increases exceed the budgeted provision in cash-limited services. The case of the National Health Service illustrates that vividly. The review body awards apply both to the hospital and community health service and to family practitoner service. In the case of the family practitoner services no problems of implementation arise, apart from complaints from doctors when implementation is staged and delayed or when the award is not paid in full. The real problems arise in the hospital and community health service because it is cash-limited.
What on earth can be done? If the cash limit is to be maintained the pay increases have to be staged and applied for only part of the year so that the budgeted provision for increased pay is absorbed over seven or eight months rather than spread over the whole year. That end-loads the system. I remember from my involvement with Civil Service pay some years ago the strictures laid down by the Treasury and Civil Service Committee about end-loading because it raises the base line for the following year. Such staging pushes the problem forward into the following year.
Alternatively the cash limit can be increased with extra money coming from the contingency reserve, as, for example, in 1987 when the Government decided to implement the pay review body awards in full. It was an election year and the Government were not wholly unmindful of these important considerations. Even then, the Treasury did not agree fully to fund the awards. In his evidence to the Treasury and Civil Service Committee the Chancellor said:
£30 million—
I think that he was wrong and that the sum was £24 million—


had to be found by the health authorities from their cost improvement programmes.
Those self-same cost improvement programmes were also expected to meet non-budgeted pay increases for non-pay review body staff and other additional expenditure that exceeded the budgeted amount. Fine, so that extra spending was being met out of the cost improvement programmes. However, the cost improvement programmes had already been taken fully into account in establishing the public expenditure figures for the hospital and community health service for 1987–88. The House will not think for one moment that when the Secretary of State goes along to see the Chief Secretary or to the Star Chamber those cost improvement programmes are ignored. They are brought into the argument. The Treasury says, "You are to get £150 million a year"— the figure announced by the Secretary of State for the current year and for next year—"and we shall take that into account in arriving at the overall figure." As my right hon. Friend the Secretary of State said, the cumulative total sum arising from cost improvement programmes over the past four or five years is £1·3 billion. In the current financial year the programmes are running cumulatively at about £600 million. If those sums had not been taken into account by the Treasury in determining the overall finances for the hospital and community health service, we should largely have overcome the funding problems that are besetting so many of our district health authorities at the moment.
My right hon. Friend the Secretary of State rightly praised and commended the NHS managers and staff concerned for achieving these substantial efficiency savings. However, their motivation to find even more savings in future years must be damaged by their increasing awareness that the Treasury is taking full account of these savings in determining the cash limits for the hospital and community health service.
My hon. Friends and others who are calling for greater efficiency in the Health Service are right to do so. However, they should not be misled into thinking that as a result of that greater efficiency more money will necessarily be available for patient care because what happens is that in the arguments during the public expenditure round between the spending Department—the DHSS—and the Chief Secretary, the Treasury and others, account will be taken of those efficiency savings.
I now look more widely at the general financing of the National Health Service. I am delighted that the Select Committee on Social Services has made that its priority subject. I hope that it will get ahead with the work and produce an authoritative and useful report. I welcome the present wide-ranging public debate, with inquiries by the King's Fund, the Institute of Health Service Management, and the Public Finance Foundation and the flurry of activity from Right-wing pressure groups such as the Centre for Policy Studies, the Institute of Economic Affairs and the Adam Smith Institute. There are many new ideas, or at least re-worked ideas because there has been an awful lot of literature on this subject in the past.
Insurance funding has often been suggested as a way out of the present difficulties. It was investigated by the Government between 1980 and 1982. However, my right hon. Friend the then Secretary of State for Social Services, now the Secretary of State for Employment, announced in a written answer in July 1982 that the Government

have no plans to change the present system of financing the National Health Service largely from taxation".—[Official Report, 30 July 1982; Vol. 28, c. 860.]
That was following the internal review of the insurance system.
It is also suggested that increased charges would bring more money into the Health Service and would also discourage use of particular services. I am often surprised that sometimes those of my hon. Friends who give a greater importance to market considerations than perhaps I do in the general run of things seem to ignore the fact that by their very nature increased charges discourage use. Perhaps, for some, that is even a positive merit. But on considering the Government's proposals for charges for sight testing and dental inspection, one is not encouraged to think that there is much advantage to be gained in pursuing increased charges as a way out of the present financial difficulties.
It is also suggested that lotteries could make a contribution. I ask instantly, "Why not?" Many years ago, Ireland used to have the hospital sweepstake. I gather that it now has a much more modern system which churns in a great deal of money and which follows similar systems used in California, Australia and many other areas. We should look at that suggestion and if it will produce substantial amounts of extra money, why on earth should we not adopt it?
Of course, at the same time we must search for increased efficiency. I remain a firm supporter of the National Health Service. I welcome increased cooperation with the private sector and am totally opposed to those who, for dogmatic reasons, regard any cooperation with the private sector as a betrayal of the cause of the National Health Service.
I am attracted by ideas for developing an internal market within the National Health Service to begin to deal with some of the problems of the enormous difference between the apparent costs of particular operations when carried out in different areas and regions. I should like the internal market concept to be developed.
I am also convinced that clinical budgeting, along the lines suggested by Professor Alan Maynard, will inevitably exert a growing influence on the way in which resources, which will always be scarce whatever arrangements are made, are best used in the interests of patient care.
Although I envisaged that all those suggestions are more likely to take place in the future, within a largely tax-financed service, alternative sources of funds deserve careful consideration. However, I must challenge the naive assumption that runs through much of the present debate about NHS financing — that new money means extra money — because everything that I know about the Treasury goes against it. As soon as new money is found and begins to come in, it will figure in the public expenditure discussions. The Treasury side of the table would, for example, say, "You are getting £200 million to £300 million from the lottery. We shall take that into account, which means that £200 million to £300 million less needs to come out of the tax-borne expenditure than would otherwise be the case." Those who argue that new sources of finance mean extra money for the service must somehow overcome the Treasury's long tradition of taking account of that money. That fact changes many of the arguments.
I am not enunciating a new doctrine. The Royal Commission on the National Health Service reported in 1979. Paragraph 21(13) states:
It must be understood that there is no escaping government supervision of health service expenditure whatever system of raising funds is adopted. Some advocates of an insurance system evidently see it as a mechanism for automatically increasing expenditure on the NHS as costs rise. They delude themselves if they do. The rising cost of health care is a major concern in most developed countries, and measures to control it may be, and are, introduced whatever the method of financing health services.
The Government will always look at the overall total amount of money going in to the service. So long as there remains a tax-borne element in that overall spending, the Treasury will take account of it. If the Treasury is to change its attitudes to new sources of funding, it might be much simpler and less administratively expensive if that change of attitude occurs under the existing system. However, perhaps that opens up wider considerations.
The fundamental requirements of the National Health Service that face us in this House and in the Government relate to the way in which we can introduce more taxpayers' money—there is no other money available in the short term—into the Health Service in the coming months. I am not suggesting a great deal more money, as have some hon. Members, but there must be more money for 1988–89 to meet the full unbudgeted costs of the 1988 pay increases plus, perhaps, up to £500 million — I certainly would not put the figure any higher—to relieve the mounting pressure on so many health authorities. The generous provision that has been made and the £700 million more that will be given to the health authorities for the coming year, 1988–89, represents a cash increase for next year of 6·3 per cent. according to a DHSS press release.
Inflation is estimated to be 4·5 per cent., and 75 per cent. of overall spending goes in pay. Does anyone think that the pay increases for doctors, nurses and midwives in 1988·89 will be 4·5 per cent. or less? Anyone who thinks that that will be recommended by the pay review body, or that, if it awards more, the Government will stick to their figure, is living in a dream world. Money is washing out, not from the second floor of the Treasury, but from the attics. In such circumstances, it is totally unrealistic to try to hold down nurses' pay to the budgeted level of 4·5 per cent.
The Secretary of State was right to point to the need for extra resources when he met the presidents of the royal colleges. The headlines read:
Moore accepts NHS cash need … Doctors' fear on future of health service allayed … Minister pledges action on funds".
The stories in the papers last Thursday morning were very different from what my right hon. Friend the Chief Secretary said that evening. My right hon. Friend the Secretary of State very properly and loyally tried today to equate the message that came out of his meeting with the presidents of the royal colleges with what the Chief Secretary said when he wound up the debate on the Autumn Statement on Thursday. But I think that the earlier simple message from my right hon. Friend the Secretary of State was right: more funds are required in the coming year.
Of course, that does not prejudge the wider questions, many of them posed by my right hon. Friend the Member

for Chingford (Mr. Tebbit). However, there is an urgent, present need, and the sooner that the Government meet that need, the better. The longer that they delay doing what I believe is now virtually certain to be done—that is, provide extra money for 1988–89—the more they will dissipate the political advantages that should flow from such action, and the more they will damage morale within the National Health Service.

Several Hon. Members: rose—

Mr. Speaker: Before I call the next Back Bencher, let me remind the House that at the beginning of the debate I appealed for short contributions. The right hon. Member for Salford, East (Mr. Orme) set an admirable example. Since then, however, we have had a 27-minute speech and two lasting for 117 minutes. May I appeal again for brief contributions.

Mrs. Gwyneth Dunwoody: Normally, when the House debates the National Health Service, it does so by arguing about how best to provide a service that is useful to everyone. Such debates are usually marked by contributions from both sides of the House that pay at least lip service to the idea that the NHS is there to provide good health care for everyone, irrespective of income.
That is not an accident. Although the Conservative party opposed the creation of the National Health Service originally, it realised very rapidly that it was not just popular, but essential. We do not need examinations of whether the system of payment out of taxation is the right one for the NHS. Never was a service more surveyed, reported on and generally commented on. The Royal Commission on the National Health Service did probably the best survey, ever, and it remains so, but we have also had the Black report—which told us what is happening to the population as a whole when the privileged decide what kind of income and housing we shall have—and a number of other surveys, from the King's Fund and other interested groups.
We know, therefore, that a service funded out of taxation, and free at the point of use, is not only the best way of providing health care, but one of the most efficient. Yet, week after week in the House, we hear the Prime Minister recite numerous statistics — most of them meaningless — suggesting that the NHS is not only improving all the time, but that a large injection of cash is understood by the population as a whole to be producing the most wonderful results throughout the country.
What is really happening in the NHS is obvious to the population, and it is fundamentally different. In my constituency, we rely very much on a large district hospital. That started closing wards, went on to close whole sections and finally changed the way in which it operated. Occasionally, it has received a great injection of cash from the Mersey authority, because it is so grossly underfunded that it has had considerable problems. Nevertheless, health care has gone on declining, and waiting lists have continued to get longer.
That is because the Government, since they first took office, have chosen to cash-limit the hospital service. They never say, when they are talking about the money available, that it is in the non-cash-limited family


practitioner service that much of the money has been spent. The hospital services have tended to suffer most. For example, in the constituency of the right hon. Member for Shropshire, North (Mr. Biffen), there is a specialised hospital—a fully equipped orthopaedic hospital—whose theatres are to be kept empty for three months. What contempt would be shown by Conservative Members if it were suggested that a fully equipped manufacturing unit, with high standards and expensive equipment, should be kept empty for three months, while retaining its staff and equipment. My goodness, we should hear about something like that. In the NHS, however, such action is regarded as perfectly acceptable.
We have problems in Oswestry with the district general hospital and with the family practitioner services, which are increasingly finding it impossible to obtain the back-up staff that they require. There is also a growing and frightening habit of suggesting that the reality can be changed with words. Nowadays, when people discuss decanting mentally handicapped patients into the community, they talk about "fast-track" and "slow-track" decanting, as if those patients were Norfolk turkeys being shoved through on a production line. We are talking about people, not turkeys. That means that we do not say, "How much of this land can we sell off? Where can we get a nice section to put money back into the Health Service? We will not use it to provide better services for people who were in institutions before. Oh, no; we shall simply put the money back into the Treasury." That is what is consistently happening, and happening consistently. It is mildly hypocritical for Conservative Members to come here and say, "Of course, we should be looking at other means of funding and improving the service", when what they really mean is, "In my constituency, I want you to spend more money, but elsewhere I want you to cut back."
Many of the smoke-screens relate to things that do not matter a damn in relation to overall finance. We can alter the administration as much as we like. Really the organisation was a disaster, and, although there have been larger cuts in administration than in other services, it still costs less to administer the NHS than it would to administer any comparable insurance-based scheme. We can alter the general way in which patients are moved from one list to another, and suggest that the provision of computer waiting lists will make a difference; but it will make no difference if the staff and funding for those specialised units are not there.
We should be asking one question of the Secretary of State tonight: what undertakings did he give to the august gentlemen who came to him, the presidents of the royal colleges, about funding? Why did the Chief Secretary make it clear the next day that in no circumstances was he prepared to support even the suggestion that the NHS was lacking in money? That is a question that the Secretary of State somehow did not find time to answer today, but it is relevant to this whole debate.
There is no better way of funding the National Health Service than by direct taxation. We know that because we have considered it time and again. There is no better way of providing health care than when people need it and letting them pay for it out of taxation. We do not solve the problems, as suggested in my district general hospital, by building a private unit of 12 beds which is supposed to produce a mythical answer that will encourage consultants to stay on the site, as if they were for ever running off. If

consultants are not doing their job, machinery exists for disciplining them and it is time the people in charge did something about it.
The real truth is that the NHS needs large amounts of money now. It needs proper back-up for the staff now. Anything that detracts from that is hypocritical, mealy-mouthed and uncaring. Those are the points that should be made time and again until the electorate understand what the Government really mean by health care.

Sir David Price: I am glad to take up the general challenge made by my right hon. Friend the Member for Chingford (Mr. Tebbit) and by the hon. Member for Greenwich (Mrs. Barnes) to consider the long-term funding problems of the National Health Service. I was interested in the arguments put forward by the hon. Member for Crewe and Nantwich (Mrs. Dunwoody), but she will forgive me for not commenting on the immediate position. As she knows, and as my right hon. Friend the Member for Brentford and Isleworth (Sir B. Hayhoe) pointed out, we who are on the Select Committee are examining the immediate funding problem. Indeed, tomorrow, if the hon. Lady would like to come to the Committee, we will be meeting the three august presidents; I do not wish to anticipate their replies.
The long term is a much more serious problem. I believe that there are solutions to the immediate problem, some of which have been suggested by my right hon. Friend the Member for Brentford and Isleworth. The long term problem is getting increasingly difficult intellectually, let alone politically. I put it in these terms. It is the exponential nature of our expectations of the Health Service. The demand consequences of those exponential expectations are likely to run increasingly ahead of available resources, even if the resources put into the National Health Service expand at the same growth rate as the economy.
The chairman of Wessex regional health authority, the distinguished mathematician who is known to some hon. Members, Sir Bryan Thwaites, demonstrated in a telling lecture at Southampton university that the demands on the NHS, projected over the next 20 years, are likely to grow at an annual rate of 5 per cent. I think I carry hon. Members with me when I say that it is equally likely that available resources will not increase by 5 per cent. a year. Indeed, I argued, when I spoke in the debate on the Loyal Address, that we should commit ourselves to a growth rate in resources from public funds to the NHS equivalent to the growth rate in our gross domestic product. Experience shows that 2·5 per cent. is the most that one can reasonably assume. That has been achieved by this Government. I do not see any alternative Government sustaining over a decade more than a 2·5 per cent. economic growth rate. Anyone who suggests more can point to no historical experience to support his hopes. Of course it would be nice to have a higher economic growth rate, but I do not see that happening.
Therefore, we must expect a growing gap between—I will be optimistic — a growth rate of 2·5 per cent. in resources and a growth rate in demand of 5 per cent. Such is the nature of exponential growth that the gap grows; so what starts at 2·5 per cent. becomes 29 per cent. over 10 years but over 20 years— that is not very long in the


lifetime of a health service — it becomes 62 per cent. That is the nature of geometric progression. That is the real problem to which the House has to address itself.
The House may think that I am exaggerating when I hypothesise, as Bryan Thwaites did, a 5 per cent. growth rate. Following your instructions to be brief, Mr. Speaker, I suggest, almost in synoptic form, some factors that have led Bryan Thwaites and myself to that view. Indeed, I think we are being conservative in putting as low a figure as 5 per cent. on the growth of expectations.
The first factor is the continuing advance in medical knowledge and in medical practice which makes possible what was hitherto impossible. We have heard all the arguments about the Birmingham hospital and about hole-in-the-heart surgery. When I first came to the House —a long time ago—hole-in-the-heart surgery was not an issue, because it did not happen.
Secondly, following that advance, there are more sophisticated treatments for more conditions. That increases the demand upon available resources. More people get more treatment. That is admirable in itself, but the process is self-generating. I need only refer to hip replacement operations as an example.
My right hon. Friend touched on the third factor, that more people are living longer. The old, and especially the very old, are heavy users of the National Health Service — surprise, surprise. So an increase in the numbers of the very old leads to a disproportionate increase in the demands upon the National Health Service. Today those aged 80 and over total 1·8 million. In 20 years they will have increased from 1·8 million to 2·3 million, or from 3·2 per cent. to 4 per cent. of the population. God willing, I shall be one of them.

Mr. Nicholas Winterton: And still here?

Sir David Price: An ancestor of mine remained a Member until he was 96. He had served the House for 64 years. I have only done 33.
Going to the other end of the age scale, the fourth factor is the survival of more severely handicapped children. A great plus for society is that many are surviving today who in previous generations would have died at birth or shortly afterwards. Many of them are multiply handicapped and for their entire mortal existence will require help. I do not think that we have begun to face up to the resource consequences.
The fifth factor is the technological advances in equipment which follow the almost explosive rate of development in science. I point only to microelectronics to illustrate the point. As a result, equipment within the service rapidly becomes technically obsolescent. Of course, the consequences affect both the capital budget and the revenue budget.
Another factor, number six, is professional expectations, which again put an increasing demand on resources. It can be summed up in the simple phrase, "My patient must get the best." That is totally honourable and right, but it is very demanding on resources. To put it another way, the more cynical might say that it is keeping up with the professional Joneses.
The seventh factor is the public's expectations, which are self-perpetuating. They are encouraged by a growing public awareness of the potential of modern medicines. These expectations apply not only to the practice and the

delivery of medicine, but to the general standards of patient care and patient comfort, which some people like to call the hotel aspect of hospital treatment.
Factor number eight is the general determination of the 1 million or so people who work for the National Health Service in the four countries within the United Kingdom that they should share in the growing prosperity of the nation as a whole. Nurses, as well as other groups within the NHS, wish to push their position up in the general pecking order of pay and remuneration. That is a major growth factor within demand on the service when one remembers that staff costs represent roughly 75 per cent. of total revenue costs within the NHS.
That is a factor that my right hon. Friend referred to. We underestimate staff expectations at our peril. There is also a desire to share in working less anti-social hours and to have more leisure and holidays, which has not been taken into account sufficiently in forward costing.
The ninth factor is the potential threat of new diseases that might make heavy demands upon resources. Last year, in the Social Services Select Committee, we were looking at what could happen to this country if the AIDS epidemic really took off. I do not wish to go on about AIDS, because everyone is probably bored with the subject and has heard enough about it. But diseases do not remain static, nor do viruses cease to mutate, merely because they are not recognised in the Treasury computer model of the economy.
We must take it into account and not be surprised if there is a new virus or, as we have with AIDS, a retrovirus, which I have described as an "Alice Through The Looking-Glass" virus. It behaves in the opposite way to a normal virus. We must expect this outcome, and not be thrown by it. Indeed, it could well be that some old disease comes back with a new and much stronger form as a result of mutations. We should be ready for the unexpected, if that is not too Irish a thought for the House at this hour of the evening.
I hope that I have said enough to explain to the House that there is a growing gap between expectations and resources, which will be present under any Government. The sooner we realise it the better. I hope that the Select Committee will be able to throw a little light on it. We will come back in a few months with a thoroughly constructive report. Whatever the Government do, we shall offer some solutions to the problem.
Certainly, in playing my own part in the work of the Select Committee, I am very conscious of the cautionary words of the Royal Commission on the National Health Service, which reported in 1979, as my right hon. Friend the Member for Brentford and Isleworth reminded us. The report said:
it is important for any Health Service to carry its users with it, given that it can never satisfy all the demands made upon it. It is misleading to pretend that the National Health Service can meet all expectations. Hard choices have to be made. It is a prime duty of those concerned in the provision of health care to make it clear to the rest of us what we can reasonably expect.
I remind the House that this Royal Commission was set up by a Labour Prime Minister, so let us abandon minor party skirmishing and try to work together, as the hon. Member for Greenwich (Mrs. Barnes) invited us to do. Let us find a solution to this very real problem. There is no pot of gold at the end of the rainbow for the NHS, but if we


play silly partisan politics with the NHS, the rainbow of hope will disappear and our constituents will be left only with the bitter tears of disappointment.

Mr. Barry Jones: The hon. Member for Eastleigh (Sir D. Price) has quoted some chilling figures. I hope that he achieves his century. It seems from this side of the House that there is plenty of life in him yet.
I agreed with the right hon. Member for Brentford and Isleworth (Sir B. Hayhoe) when he called for urgent money in the short term for the National Health Service. I thought that he spoke with some insight into the Treasury. He should know; he was speaking from experience.
Yesterday, 17 Labour Members of Parliament from Wales met the Secretary of State for Wales, and also his junior Minister, and senior health advisers. It was a serious session and a businesslike encounter. We told the Secretary of State for Wales of the problems in the south and north of Wales, in the urban and rural areas and in the industrial valleys of the south-east.
We said that every health authority in Wales claimed that it was underfunded. Each Welsh Member of Parliament gave convincing examples of underfunding. There were reports of low morale among ancillary workers and of consultants being told to treat fewer people. There were calls for more hospitals, and for more nurses in special and intensive care units. We urged the Secretary of State for Wales to put a paper to the Cabinet, and use it to argue for more and urgent funding to deal with the very pressing and real problems in the Principality. We said that he had a crisis on his hands and that he would need much new money to cope with the problems that we reported to him from our constituencies.
The people of Wales have special needs. We still suffer from major unemployment. Nobody would deny, that, arising out of mass unemployment, there are greater demands on the Health Service. We still have in Wales an unenviable reputation for ill health, specifically for heart disease, which may come top of the league in Europe, and, arguably, in the world, and for other diseases related to smoking.
We gave the Secretary of State some woeful instances of the cycle of deprivation. There are many deprived, under-nourished, under-privileged and unemployed communities in Wales. We pointed to the problems of the economy, where basic industries are declining. We know that in mining there are special health problems, and we are having to cope now with mine-working throughout this century.
We know that our housing problem is the worst in Britain; we have more houses that were built before 1917 than any other region. We know that housing conditions are directly related to health.
Major steel closures have taken place in the 1980s. Some of the steel communities are still reeling from those closures. There are consequences for their health and demands for health care. We could argue that the Health Service might have been conceived or invented in Wales. Certainly, it was the great Aneurin Bevan who put the Health Service together for the people of Britain. His achievements have been great and lasting. He said that preventable pain is a blot on any society and that a society is spiritually healthier if it has access to the best of medical skills.
I shall briefly instance the difficulties faced by the Health Service in Wales by specific reference to my constituency. Many people in north-east Wales who suffer from cancer cannot get treatment there. My constituents have to travel to Mersey hospitals. This year, as before, we were promised a major new community hospital, which was to have been started in 1985. It will probably not be started until next year.
The neighbouring district health authority is Chester, and thousands of my constituents receive treatment there. But I have received letters from consultants in Chester who complain of the worrying situation because they are required to cut back their care. There is a major hospital in Shropshire, which was referred to by my hon. Friend the Member for Crewe and Nantwich (Mrs. Dunwoody), at Gobowen. Beds are being taken out of service there, and wards closed. That hospital serves north-east Wales, and the consequence of cuts there is very real to my constituents and the people of Clwyd.
I can tell the House of a young woman in my constituency who had trouble with her ear. She had to wait for two years before she could have treatment, when it was discovered that she had a hole in her ear-drum.
We have a special school in my constituency. There have been complaints about there being insufficient incontinence pads available for the daily working of that school. Cuts are planned in a much cared for hospital in Holywell, the Lluesty hospital; and many of my constituents have complained bitterly to me about the likely consequences of those cuts.
The Secretary of State in his speech—not a happy speech — said that he wanted to see the use of spare capacity. The experience of my constituents is that there is insufficient capacity. Indeed, there are cuts not only in my area, but in neighbouring health authorities. I will instance the result of a very distressing one. On the eve of Christmas, the Daily Post, a newspaper in north Wales, reported as follows:
Chester district health authority is facing a demand for a government inquiry over the hospital transfer of elderly orthopaedic patients in a huge van.
The front page has a picture of that four-ton red Bedford van. The article goes on:
Said one hospital employee: 'The van was dirty, freezing and smelt of something like stale cheese. Nurses were crying openly. They could not believe that this was actually happening.'
That was also reported extensively later in the Mail on Sunday. I bring it to the attention of the House because the very unfortunate manner in which two elderly citizens and patients were transported between hospitals on the eve of Christmas was the consequence of cuts, however temporary. That does not sit well with the posture of the Secretary of State for Social Services. I go further and say that it is vital to maintain the quality of our social services and to ensure that they are fully available to those who most need them.
Governments exist to ensure that the strong do not tyrannise over the weak. It is necessary to care for the nation, for the whole of society, and to express that care.
Those are not my words. They are the reported words of the former right hon. Member for Cambridgeshire, South-East, a former Cabinet Minister, now ennobled and in another place, Lord Pym. That was perhaps one of the toughest and most bitter speeches made by a former Cabinet Minister in the autumn of 1983, but I think that he summed up the situation.
Social justice demands that Her Majesty's Government should provide more financial support for the beleaguered National Health Service. It is my fear that before very long, unless there is urgent Government action, we shall have two forms of health service: one for the rich of our land, a Rolls-Royce service that can provide miracles, the best of health services for the very privileged; and the second, which we are in danger of getting, for poor people —a system that is shabby and does not deliver the best and most needed services.
That is the drama of the situation in which Britain finds itself today, and unless the Government, in their remaining years in office, are prepared to find the funds and take the decisions, our Health Service may be lost to all the nation as a free service giving the best of care, as the great Mr. Bevan would have wanted it to do.
My demand is that we avoid the temptation of tax cuts to buttress the political standing of the Government among the upwardly mobile. Indeed, Her Majesty's Government should realise that the divisions in British society which are now manifest and growing could be narrowed and partly eliminated if our Health Service were made better. The Health Service in Britain can be a unifying factor for all our people. Major tax cuts would put massive pressure on the balance of payments problem that will face our country for the immediate future.
Huge investment or even urgent investment in the Health Service would create work and give greater happiness and security to countless families.
I urge the Government to think again about their attitude and strategy and, when the Budget comes along, or even before, to give massive new funding to help our National Health Service.

Dame Jill Knight: Perhaps I should begin with the charges. The charges made against my right hon. Friend and the Government today deserve to be rebuffed with energy, determination and, indeed, contempt. I say contempt because of the disgraceful personal attack on the Secretary of State over his recent medical treatment. The Opposition really have it both ways on this. Had my right hon. Friend not used some of his salary to pay for his own medical attention and therefore had taken up a bed in an NHS hospital he would have been under attack for that. I have always understood that the Labour party believed in rich people paying for what they get and not getting it for nothing.

Mr. Jeremy Corbyn: rose—

Dame Jill Knight: No. Mr. Speaker is anxious that all Members be very swift in their speeches, and I intend to be so. The hon. Member can make his own speech.
When people are in receipt of a fairly high salary for the job that they do, it seems to me to be absolutely right that they should pay for their own health care and leave a bed available for someone who is less well off.
As for the remarks made a moment ago by the hon. Member for Alyn and Deeside (Mr. Jones), who seems to be about to leave the Chamber, he is quite wrong about the private sector. All too frequently the National Health Service is the one that provides the highest standard of

very complicated care. In many cases, if very complicated cancer or other treatment is needed there is nowhere but the NHS to get it. For that, too, I salute the NHS.
We affirm that our Government have an extremely good record. We are not saying that every last thing has been done, every last "t" crossed and every last "i" dotted. But we are saying that there is an extremely good record to talk about. Almost unimaginable extra funds have already been made available.
The hon. Member for Greenwich (Mrs. Barnes), who does not grace the Chamber with her presence for very long, said that the Secretary of State cited the extra amount of money spent and said that all was well. He did not say that all was well. None of us on the Government side of the House would say that all is well with the Health Service. We are as anxious and worried about the difficulties that come to our notice as any Member of the Opposition. But we are entitled to say that very large sums of money have been made available. Waste and inefficiency have been tackled as never before, and goodness knows action was very badly needed there. They would never have been tackled by the Labour party.
The recruitment of doctors and nurses is up, with substantial extra money being paid out in salary increases. There are far more patients going into hospital for treatment and far more being dealt with in out-patient clinics as well. Of course, it is also true that there are people waiting for treatment, but we are spending very much more money on extra treatments, extra doctors, and extra nurses, and all of these are being used to help patients in the NHS. And we are to a certain extent victims of our own success. We are short of money because so much is being done. If so much were not being done, we would not be short of money.
The press seems to concentrate exclusively on those people who have not had treatment. There is a lot of emotional mileage in postponed operations and closed wards. Some papers with more space than taste print pictures of funerals, wreaths and tears. If that happens, it is fair enough, but surely something should be said sometimes about the tremendous number of people who are getting treatment. Is there no emotional mileage in someone having a cornea transplant and suddenly being able to see, or having any of the other transplants which miraculously, although expensively, are now available, such as coronary artery bypass grafts? Surely there should be some human interest in that, but we never see any stories of that kind in the press. The only accounts are those of people who have not immediately been able to have treatment.
Statistics do not count very much to those in need of treatment. It is rather like being unemployed. If you are not unemployed, it is not nearly such a 100 per cent. issue as when you are unemployed. Many people are getting treatment and the media should highlight their success and the alleviation of their conditions.
The press and some Opposition Members tell us that everything is fine everywhere else in the world and that only the NHS is in terrible trouble, but is that true? As we have been reminded, heavy cuts in expenditure are being made in West Germany where there is huge overstaffing in many hospitals. There was an estimate at the weekend of 50,000 beds lying empty at great expense. Opposition Members will be riveted to hear that in Russia they cannot even provide lavatory paper in the hospitals, let alone vital drugs. In Italy, hospital patients have to provide their own


food and strikes by nurses and doctors are common. In France, the Health Service is described as being on the verge of bankruptcy. Although I warmly recommend Greece as a delightful place for a holiday, I do not advise hon. Members to become ill there because its health service treatment is appalling. We all know what happens in the United States where many people are literally bankrupted when a member of their family is ill.
I was disappointed that my right hon. Friend did not say very much about future funding of the National Health Service. As is apparent from many of tonight's speeches, there is real concern about getting more money for the National Health Service. The figures need careful examination, given that inflation in Health Service technology is far higher than it is in the outside world. We need new pieces of equipment and we want to buy them when they come on stream, but they are extremely expensive. There are growing numbers of elderly people and the problems that we shall have to face on that score are very severe. We do not know how much we shall have to spend on AIDS. The amount we spend on abortion is amazing. We must consider all these matters when discussing funding.
The cost of drugs has increased very much. The Government deserve a bouquet for having brought in the restricted list. Let nobody deny that that has given an extra boost of money to the National Health Service. Although, at first, there was an immense row and the Opposition were in there fighting, we hear nothing about it today because the idea has been a great success and has saved a lot of money. The Government do deserve credit for that.
We need two sorts of cash. First, we need an immediate cash increase because we all know places where more cash is needed. The trouble is that it is virtually impossible to be told how much is needed to end the problems. Secondly, we must consider long-term funding. The Opposition attack us on the Health Service because there is nothing else on which to attack us, but they are on a false trail.

Mr. Robert Litherland: The Opposition make no excuse for highlighting the starvation of resources and finance in the National Health Service and its contribution to hospital problems. Not a day passes without reports of hospitals facing extreme problems of finance and manning levels in their attempts to provide a medical service to people in need in their catchment areas. Rural cottage hospitals and major inner-city hospitals are in a state of crisis unknown since the introduction of the National Health Service.
I shall take one hospital which epitomises the situation in the National Health Service. The Manchester royal infirmary in my constituency is a hospital whose management continually strives to achieve a balanced budget. It has sold land and property belonging to the hospital, introduced privatisation, reduced general nurse training, reduced midwifery nurse training, consolidated operating sessions in one fewer theatre and saved through early retirement and changes in shift work patterns, yet it still faces an overspend of £1 million. The Government are coming back for further cuts. In fact, the hospital is a victim of its own efficiency.
What have been the consequences of this budget balancing? The Manchester royal infirmary now faces the worst crisis in its 200 years of existence, because the word

"bankruptcy" is being bandied about. This is confirmed by letters being sent to 2,500 hospital staff, saying that the hospital may not be able to pay their wages.

Mr. Favell: Will the hon. Gentleman give way?

Mr. Litherland: I shall not give way, because I know from experience that the hon. Gentleman's intervention will be longer than my speech, and shorter speeches have been requested.
Balancing budgets by delaying payment to major suppliers has resulted in a debt of £5·6 million. The suppliers are now demanding payment and threatening to cut off these vital medical supplies. What are the consequences of this situation? Just before Christmas. I was informed that babies are dying because the intensive care system has collapsed; five cots for premature babies were closed at Christmas. The electricians came in to cut off the oxygen supplies. These are not the words of politicians making political capital out of that sad situation. They are the words of the head of the special care baby unit at North Manchester general hospital.

Mr. Stephen Day: rose—

Mr. Litherland: Young women with abnormality of the cervix are turned away because the hospital cannot cope with an increasing waiting list. Women are already facing a six-month wait for treatment and, because of lack of funds, there is no possibility of cutting that waiting list. There are cuts in nursing and closures of wards and operating theatres. Babies are turned away and young women with cancer of the cervix are refused treatment.
All this is happening in one hospital in an inner-city area that has suffered enormously because of the Government's policies. The area is more reliant than ever on a good hospital service. There is a correlation between unemployment, deprivation and bad health. Once again, these are not the words of politicians, but the findings of a report by eminent people in the medical profession. Life expectancy in my constituency is well below the national average. The child mortality rate is higher than the national average.
In an article in the Manchester Evening News, a Dr. Thatcher—I shall not hold his unfortunate name against him—reminds us:
In South Manchester, all the cost-efficiency savings that can be made have been made, and we arc now down to the bone. There's basically no money for new developments so this means the so-called contingency plans are drawn up—and we've seen this happen before in the last five years—and the wards are closed about four to six months later. Or the contingency plans have a lot of adverse publicity which dies down, and then, usually around May or June, the bed closures are put into operation. We've lost over 250 acute medical and surgical beds in South Manchester in that time.
He goes on to point out how two-faced the Government are. They are consistently praising the hospital service for being more efficient, which means more patients are being treated. He says:
Wythenshawe Hospital has the highest clinical performance indicator of any major acute hospital, therefore by definition it is highly efficient. But because it is so efficient and attracts patients throughout the North West region and elsewhere, we are to be penalised by the administration who say they haven't got the money to treat all these patients.
The patients come to Wythenshawe and Manchester royal infirmary for special treatment that they cannot get anywhere else.
In this debate we have talked about other means of finance, but what has the hospital service come to when


90 per cent. of the equipment in the intensive care unit at Manchester royal infirmary has been bought with money raised by its staff? What has the hospital service come to when ultrasound scan pictures of unborn babies are sold at £3·50 a time to raise money? Hospitals cater for weddings and other functions, sell babywear, even book trips on Concorde and develop shopping malls, all in an effort not to increase the hospital service, merely to maintain it and to ensure that it continues to provide a service. That is happening in what the Prime Minister and Chancellor inform us is a buoyant economy, when consideration can be given to a further cut in income tax. It is the Government who are sick to allow this unnecessary predicament to exist. Babies are turned away to die when tax handouts can be given to the rich.
The Government should listen to the leading doctors when they inform us that the NHS is on a downhill slide. They should listen to the dean of the medical school at Manchester university when he informs us of the dangerous impact of the cuts on undergraduate medical education. They should listen to the nurses who are forced to strike because they cannot exist on a pittance and with poor service conditions.
For their pains, the nurses receive snide insults from Conservative Members about lining their own pockets. The former chairman of the Conservative party, the right hon. Member for Chingford (Mr. Tebbit), referred to nurses moonlighting. That is rich coming from a man with so many directorships. From being held in high esteem as angels of mercy, nurses suddenly become devils of greed. There has been talk about shroud waving and whingeing.
Above all, I ask the Minister to listen to the people who are in desperate need of treatment—to listen before it is too late for them and too late for the NHS.

Sir Rhodes Boyson: The genesis of the Health Service came in the Labour Government after 1945 at a time when, after total war, there was a feeling on both sides — more strongly on the Socialist side than the Conservative side — that, having won the war by a concentration of resources and people, one should win the peace in the same way. The National Health Service represented that.
The National Health Service is a nationalised, not a national service. I shall define the difference between the two shortly. The Health Service was nationalised at the same time as the railways, the coal mines and all the rest. It involved the nationalisation of 1,000 voluntary hospitals, 500 municipal hospitals and many private hospitals.
At the time, nationalisation was popular. The general climate of opinion in Britain among Socialists was strongly in favour of it and the Conservative party was halfheartedly in favour of it, if I may put it that way after reading speeches of the time. The National Health Service grew out of a time when nationalisation was a popular policy in Britain.
Since 1948, 40 years have passed and three things have happened which have led to the crisis in the Health Service. This is a crisis not just of resources, but of design—whether the service now meets the needs of the present time. That must be said to Opposition Members, each of whom I respect.
It is interesting that no other country has followed our example. If ours was the best service in the world, people would be coming here to see it. The NHS grew out of a general belief at that time and out of the Beveridge report, as all of us know.
Nationalisation, in the view of the general public, is entirely different now from what it was between 1945 and 1951. That is why the Conservative party has fought three elections on denationalisation and has won with votes from all classes in our society. Nationalisation is no longer seen as a great frontier advance. It is now seen as something to be rid of, so that we can return to some form of competitive enterprise for the benefit of all classes and groups in our society.
The second difference is the rising standard of living. Rationing was all around us between 1945 and 1951. That has gone. People then were used to waiting. I am not making a virtue of that, but people were used to waiting. The war meant that rationing continued for a considerable time.
That time has gone. Now, 16 million people holiday abroad. People buy videos and cars. They do not expect to wait. They do not go to the travel agency to be told that there is a queue and that they should come back in two years' time when they may get a holiday in the back streets of Turkey. People read their brochures, save their money and go away when they want for as long as they want.
The outcry about queues in the NHS is because queues do not exist in any other area. People realise how important health is. All hon. Members do. That is why so many have been present for the debate today. The Government must be given credit for the change in people's expectations. The Government are responsible for the economic advance and, in particular, for how much better off those in work are now than ever before. People are no longer willing to join queues for a long period.
Thirdly, great technical advances have been made and the cost of medicine has increased. Many of those advances were unheard of 40 years ago. It is always well to go back to first principles, and one reads in the Beveridge report an estimate of what the NHS was expected to cost. In 1945 it was estimated as £170 million. Index that for inflation and we now are spending 10 times more in real terms than Aneurin Bevan—all credit to those who brought it in—thought it would cost at that time.
First, nationalisation is no longer popular. We live in a denationalising age. Secondly, people are not prepared to queue because the consumer goods society has given people a taste of getting things when they want them. Thirdly, technical medicine has become very expensive.
Let me define the difference between a nationalised and a national Health Service. A National Health Service is one in which the Government somehow ensure that all parts of society, including the poorest, get health care. No one in this House would disagree with that. However, the Government do not need to provide that health care; they need to ensure that it is available to everyone. Local authorities now use competitive tendering for their services, and they do not provide them. They ensure and expect that the best service available is obtained. No longer do we need a nationalised Health Service.
My right hon. and hon. Friends and I differ in this continuing debate. Often, these days, we Conservatives have to provide our own debate within the party, which is sad, but I am glad to contribute to that debate. There


is something wrong with the design of the system. I shall not throw figures around; I shall be brief. We now know that we have more than twice as many nurses as we had in 1960 — 480,000 as against 236,000. We have fewer hospital beds, and a shortage of nurses that we did not have then. The ordinary man or woman in the street might say that that looked odd, and he or she might have a point. I have some odd figures to illustrate this, which are interesting but do not require deep analysis. On one set of figures—many are going around—510,000 more people are employed in the Health Service now than were employed in 1970. Since 1970, the population of this country has risen by 500,000. So we are employing 510,000 more staff for a population that has grown by 500,000. Thus, on a straight-line graph projection, there will come a time when more people are employed in the Health Service than live in this country. It will not happen in our lifetimes, but the man or woman in the street or in the public bar—on second thoughts, we are all in the saloon bar now, thank goodness — may say that that is odd. And I say that he or she may have a point.
Because of the lack of time, I cannot advance a detailed scheme now; nor do I have one ready. Bright lights in dark corners, I always say, and one must start looking at what must be done to improve things now. Money must follow the patient. Wherever there is a service in which the money drips down from the top there will be massive numbers of administrators, and a lot of the money will go to the wrong places. Money following the consumer is the basis of denationalisation, and consumer control has transformed so much of the economy of this country which before was an economic dinosaur.
Some form of insurance will have to come. The Government's job will be to ensure that all the people can properly insure themselves. It will cost somewhere between £300 and £500 per person. Three booklets that have come out recently — the author of one is sitting on the Conservative Benches now— on the subject all give different figures, so if I average the lot, we shall say that it will cost £400. Every person in the country could be given a voucher for £400 for health insurance. It is the same system as we have for car insurance, which is not done by the Government. One insures the car, and the insurance company has to provide the service so that one is not bankrupted. That is one way of doing things.
The trade unions began as benevolent—

Mr. David Hinchliffe: rose—

Sir Rhodes Boyson: I have no intention of giving way. I have made up my mind on that, which is a good thing to do in society. The hon. Gentleman is a good man and I have the greatest respect for him. Long may he remain up there on the Back Benches. No: why not welcome him to the Front Bench in a generous-hearted way?
The trade unions, which are losing their meaning these days, could go back to being the benevolent societies that they began as. In France, one can insure with a trade union. After getting the bill, one goes along and expects to pay something oneself, and the trade union pays the rest. If people cannot pay, they go to social security. It is a relatively effective system, and I inspected it when I went to France in the course of my ministerial duties.
The Government lack the wisdom—even more now that I am no longer a member— to run 1,800 hospitals effectively by means of Ministers, civil servants, regional

and area boards, trades unions and professionals, who are all battling for control. It is no wonder that efficiency is lost somewhere along the way. So why not denationalise many of these hospitals and, as happened with the Wembley hospital, which began under local control, put them back under local control? They would raise vast sums of money. Why cannot the trade unions take some of the hospitals? Why cannot the churches? That would give them something to do at last. They spend enough time talking about social events. Why cannot they take some of the hospitals over? It would give them something to do. Why do not the workers take some of them over? The Opposition believe in that until it happens. Why do not these people take over the hospitals and answer to the market?
The hon. Member for Livingston (Mr. Cook) mentioned me in his speech, and I am always grateful for that. He talked about whether the churches could do something, mentioning the Church of England. As a Methodist lay preacher, I never mentioned the Church of England; I think that the non-conformists can take their share. On behalf of them, I make that point.
I have said it outside the House, and I now say it here: this problem is the Government's Achilles heel. As one who has suffered from that trouble, I know how painful it can be until it is cured. The House, in its charity, will allow me to mix metaphors. This problem could become the Government's albatross, with the ancient mariner, in different garb, sitting outside each hospital. The problem will have to be dealt with. It is no good doing it piecemeal, either. While sorting out the immediate problems, the time has come to change the whole basis of the Health Service's design. It is antiquated and will have to change. I only hope that the Conservative party, of which I am proud to be a member, will be as radical in social matters as it has been in economic matters. The Government have put the market in control in economic matters to the advantage of everyone in society, and I trust that we shall do the same for health, so that everyone, from the poorest to the richest, can be dealt with, not by a nationalised Health Service but by a national Health Service.

Mr. Sam Galbraith: In contrast to that of the right hon. Member for Brent, North (Sir R. Boyson), I enjoyed the contribution made by the hon. Member for Eastleigh (Sir D. Price) and his excellent analysis of the stresses and demands on the Health Service, and I agreed with part of the reason he gave for the problem. He outlined the numerous things that put pressure on the Health Service, but I want to take issue with one part of his analysis. He spoke about demands. There is an important distinction to be made between demands and needs. We should try to meet needs, not demands. Demands do not necessarily correspond to needs.
The advantage of the Health Service is that it is more related to need, which it can control and examine. A private system, such as that suggested by the right hon. Member for Brent, North, leads to a system that is demand-led. Then there are difficulties in fulfilling people's expectations from available resources. I hope that the hon. Member for Eastleigh will take that into account. Only the NHS deals with need; private systems deal with demand, which has only a tenuous relationship with need.
I want to address some other points about the market and the National Health Service that have been made by hon. Members. I shall deal, first, with another factor that is used as an excuse for the problem. We have heard that the consultants, the nurses and, finally, the Minister himself were to blame. Another factor is known as the bottomless pit. We always hear about it, but I do not think that health care is a bottomless pit. It is certainly true that health care expenditure can and does increase rapidly, but that is true of every country and health care system in the world.
If Health Service expenditure is to be controlled and used correctly, the most fair — and the only — way of doing that is to have a National Health Service. In the National Health Service, which is a system based on need rather than demand, staff examine new techniques and treatments. Doctors and nurses in the NHS agonise whether treatment is needed. They must go through the whole system before eventually deciding that treatment would be appropriate under the National Health Service. During the past few years, having looked at new techniques and systems of care and decided that they will meet a need, doctors and nurses find that there is no money with which to meet it. That is the crisis in the National Health Service.
We have heard a lot from Conservative Members about the market philosophy and the National Health Service. It is not appropriate to look at the National Health Service and the health care system in those terms. Silly statistics were quoted by the right hon. Member for Brent, North. He said that we have many more nurses but fewer beds. I will tell him the reason for that. Intensive care units, which we did not have in the 1960s, require about 50 nurses. Before the 1960s those nurses could have looked after seven or eight wards with 40 or 50 patients.
The market economy does not apply to the NHS, for a number of reasons. The first relates to consumer knowledge. I cannot make an absolute statement that within the health care services consumer knowledge is limited, but it is not easily defined. The lack of consumer knowledge is part of the reason for not applying a simple market philosophy to the NHS. Secondly, there is no competitive advertising, because advertising is against the General Medical Council's code of practice. There can be no advertising within the NHS. I suspect there would have to be some arm-twisting to get the GMC to change that.
The right hon. Member for Brent, North likened health care to choosing a holiday from a range. However, when we choose a holiday, we must look at our finances to see whether we can afford a holiday in a far-flung part of the world or whether we will have to take a holiday nearer home. That choice is based on resources. However, if someone needs an important operation, such as a gastrectomy or a neurosurgical operation, there is no such range of choice. A person cannot say, "I have limited resources, so can I have only half of my brain tumour removed?" That is an important reason why the market philosophy is not relevant to the National Health Service.
We constantly hear the Secretary of State talk about better value for money, and in particular about clinical efficiency. First and foremost, that is not a new concept for me or for other Opposition Members who have been campaigning for years that resources should be used much more efficiently. The Government have not listened. We

recognise the great discrepancies in the use of operating theatres, beds and investigations. The Minister must realise that improved clinical efficiency will cost more money. It is not a substitute for putting money into the NHS. It will cost more money if a bed is used by five patients in a week instead of by one patient. If an operating theatre is used by more patients, it will cost more money. We need more money to treat more patients. We do not want clinical efficiency because it will save money. We want the correct and proper use of resources that have been under-used to benefit the patients and eliminate waiting lists.
The right hon. Member for Brent, North and other hon. Members spoke about alternative systems. I want to clear up a few fallacies about the United States and various European systems. First, the administrative charges in those systems are much higher than ours. We hear all the nonsense about the National Health Service being a lumbering bureaucracy. It is not. In the National Health Service 5 per cent. of the costs are used for administration. In some parts of the United States that can be up to 31 per cent. of the costs. Is that what Conservative Members want?
When we examine the care provided in those systems which are demand-led, not need-led, we find that many more operations are done. I shall give some examples of that from Mr. K. McPherson in Social Sciences and Medicine:
Regional Variations in the Use of Common Surgical Procedures.
It says:
Hysterectomy rates in the US and Canada were around three times greater than for England and Wales. Similarly Prostatectomy was around two and a half times more common in the United States and Canada than in England and Wales, while tonsillectomy was around twice as common.
That is what happens in a private, demand-led system. I understand the reasons for that. I have worked in such a system. If a difficult clinical decision is involved as to whether an operation is needed, in a demand-led private system an important aspect is that it will receive £1,000 for the operation. That is a reason for the discrepancies. That is why those systems are subject to such pressure.
In Britain, doctors agonise too much about whether to carry out an investigation or an operation. In demand-led private systems they do not think about that. They go ahead with the investigation or the treatment. I have worked in both systems, and that is what happens. It is part of the reason for the escalating costs in private systems, and that cannot be controlled in a demand-led system as opposed to a need-led system such as the National Health Service.

Mr. Ray Whitney: I wonder whether the hon. Member for Strathkelvin and Bearsden (Mr. Galbraith) saw the report in The Sunday Times which compared the experiences of a man in Bristol with that of a man in Germany. They had both had heart attacks, but the man in Bristol had to wait 15 months for his operation and was out of hospital within a week. The German was immediately given his heart operation and was given three weeks for recuperation in hospital and another six weeks of convalescence. That is another example of the service enjoyed by Germans compared with the British system.

Mr. Galbraith: The hon. Member for Wycombe (Mr. Whitney) has highlighted our case for the need for more money within the NHS to provide a better service.
Finally, the Minister made great play about primary care and how it is a way forward. The primary care sector is the back bone of our system. If we change to a demand-led system, we will eliminate primary care and people will be pushed off to specialists. For all those reasons, I should like us to consider no further the question of demand-led, private health care.
We cannot apply market forces to health care. The correct and proper system is the National Health Service. Resources are limited and we have to ration and use them properly. We want that rationing to be based on medical need, not on some nebulous demand stimulated by private finance. The most cost-effective and cost-efficient way of doing that is through the National Health Service. That is why Opposition Members wish to sustain the National Health Service, and ask that it be given more money.

Dame Elaine Kellett-Bowman: In Lancaster we do not fear but welcome the Secretary of State's determination, put forward so forcefully, to compare costs and achievements in the regions, because we would do well on any tests so far devised and any he may put forward. We welcome the extra £100 million that the Government gave on 16 December. Contrary to the local gloomy forecast that Lancaster's share of the additional £5·8 million allocated to the north-west would be "negligible if anything", we got the largest district allocation of £600,000. That was good news for Lancaster and it goes some way towards meeting my plea that we need more money because 23 per cent. of our population are aged and need a great deal more care.
Twenty years ago in Lancaster the decision was taken to centralise hospital services on the Royal Lancaster infirmary site for midwifery, elderly services and acute services. Since then our programme has gone ahead steadily, except for the unfortunate check in 1978 referred to by many hon. Members when all hospital building was halted abruptly by the Labour Government because of the financial crisis. That delayed our progress, but phases 1 and 2 for maternity and elderly persons have been successfully completed. Phase 3 for acute services is at the planning stage, as announced by my right hon. Friend the Minister for Health when he came to Morecambe in the autumn.
As new facilities are provided, old ones must close, and regrettably that leads to much heartache. The Beaumont hospital, which is to be closed, was built as a fever hospital with widely spread buildings to insure against cross infection. It is unsuited to modern needs and is wasteful of the time of doctors and nurses. It is definitely not in the best interests of the health services in Lancaster to campaign for it to remain open when the specialist facilities can be provided elsewhere. Discussions are now under way in the health authority to decide where to reprovide the specialist facilities currently provided at Beaumont. It is still in the melting pot, but if it is decided to provide them at the RLI — which, I believe, is the best place for them, because all the advanced support facilities are available on the spot—the building of a new ward block for ear, nose and throat, dental and neurology services could begin in April, and the £600,000 additional funding will cover most of the cost.
At the same time, the accident, emergency and intensive care facilities at the RLI will be upgraded. When I saw those facilities yet again at Christmas I was horrified by them. Given that we are near the motorway, where, sadly, many multiple accidents have occurred, it is absolutely essential to upgrade our emergency and intensive care services.
On Friday I received news that services will have to be reduced in the orthopaedic and accident and emergency departments, not because of a shortage of funds, but because we are short of six junior hospital doctors, For whom we have been adverising since October. We recruited one on Friday and we hope to fill the other posts in February. When we do, the facilities will again be opened. Another hospital in the north-west has had to close its maternity ward, for the excellent reason that 11 midwives are on maternity leave.
In Lancaster we are proud of our leading role in many aspects of health care. We lead in the proportion of our children who are immunised. Having a large elderly population, a year ago we purchased laser equipment for eye surgery. Because our citizens are intensely proud of our reputation for health care, since for many generations we have been the primary hospital area for the whole of the north of Lancashire, up to Cumbria, we have raised £10,000 to buy another keratometer to use in the eye unit, and the local service for cataract sufferers has been revolutionised. No longer must we send patients to Liverpool or Manchester for the measurement and supply of customised lenses. Some eye patients, who had to spend lengthy stays in hospital, can now return home the same day, or after only two days, and up to 160 patients per week can be dealt with at clinics.
The new techniques have reduced the numbers of beds required from 24 to 14. That is a reasonable way to reduce beds. Nobody can say that we have lost the beds; we have made them unnecessary because of the rapid treatment in that specialty. But I do not intend to let the Government off the hook. In our large district, which covers 170,000 people, we have only one orthoptist, and we would like another to detect the early stages of glaucoma and to treat squints in children
We are an efficient health district and our treatment costs compare favourably with those of other areas. Our good housekeeping keeps waste to a minimum. We had a limited list for drugs long before the Government brought it in. We are always looking for ways to improve efficiency and reduce unit costs. We never rest on our laurels. We believe in cash generation and, before it became the fashion, we were winning orders for outside laundry contracts to keep our modern machinery fully occupied and reduce the cost of our own laundry. Money allocated to Lancaster is never wasted. We would dearly like to build on the immense progress we have already made and to cut our waiting lists for miraculous treatments that we could not even have attempted a few years ago. We are determined to provide for our citizens in the future, as we have in the past, the highest standard of health care that modern techniques can achieve. We are looking to the Minister and his colleagues to ensure that we get a fair share of the health cake.

Rev. Martin Smyth: Despite the crystal ball gazing of my friend from past years, the right hon. Member for Brent, North (Sir R. Boyson), I agree with the


Association of the British Pharmaceutical Industry which said that for the foreseeable future health care will spring predominantly from the Health Service. It is important to put on record the words of the association's director of public and economic affairs, who said:
But ideologically based criticisms of the NHS and/or its funding and performance from both the extreme left and the extreme right which exaggerated … its failings should not be allowed to obscure the successes of the British health care system.
I believe that would be the view of most people and most hon. Members.
In the light of the pressures on the Health Service, the only real grain of comfort I got from the Secretary of State was when he said that this is the 40th anniversary of the Health Service. I was reminded of the old saying that life begins at forty, so there is hope that we can build on the success of the past.
The question from the right hon. Member for Plymouth, Devonport (Dr. Owen), which was not answered, was not whether the recommendation should be funded but, if the Government decide on a salary increase, whether that would be funded fully by the Health Service rather than the health authorities. That has been the source of tremendous discontent and problems in the past.
It is difficult to find factors to assess efficiency. Some authorities and hospitals are seeking to change the system of health care by providing more day care in hospitals, but the National Audit Office did a survey at midnight, so those hospitals that were efficiently using beds during the day were penalised. It would be better to take audits at midnight and noon to establish the real use of beds. The National Audit Office has taken figures on the use of operating theatres which showed that some hospitals had a high usage of theatres. On closer scrutiny it may have been discovered that the nursing staff and theatres were ready for the operations, but on many occasions the surgeon was not in post, so the theatres, as well as the equipment and staff, were not being used efficiently. I make that point to remind us all that it is not just a simple matter of assessing efficiency; other factors must be borne in mind.
I hope that when the Minister replies to the debate there will be an understanding that the funding of the National Health Service should not only keep pace with the growth of GDP — if I understood the Secretary of State's statement correctly—but should raise the proportion of GDP to meet need throughout the nation.
I am speaking particularly as a representative of Northern Ireland. The hon. Member for Alyn and Deeside (Mr. Jones) said that Wales was the most deprived area of Britain. I do not wish to bandy figures, but the region that I represent suffers from the highest number of deaths from cancer of the colon, which is 30 per cent. higher than other regions, diabetes is 25 per cent. higher and ischaemic heart disease is 60 per cent. higher. Unemployment is also higher than in any other region, which accordingly has a health impact.
I know that expenditure on health in the region is 25 per cent. greater than that for England and Wales, but professionals in the service say that it does not meet the present need.
I regret that recently there was a public dispute between the Under-Secretary of State with responsibility for health care in Northern Ireland and the chairman of the Eastern

Health and Social Services Board, who is a careful economist. He judiciously chooses his words, and during his chairmanship there has been a tremendous increase in efficiency. The area caters for more people than in any other region in the United Kingdom not only in the health sector, but in social services as well.
It is necessary to take a hard look at the facts. In Northern Ireland, between June 1981 and June 1987, not in exotic surgery or treatments but in everyday medical care, there was a 16 per cent. increase in ear, nose and throat cases, a 56·5 per cent. increase in plastic surgery and a 51·7 per cent. increase in general surgery waiting lists, despite the acknowledged efficiency of the Province. We are faced, as is every other part of the nation, with the challenge of our own success. It is to that that we must direct our attention.
I used normal surgery as an illustration rather than what I called exotic surgery because those who can paint a dramatic picture of need in particular specialist cases —heart surgery, renal treatment and such like—often use emotional blackmail, which catches the imagination of some of the media, and indulges in a bit of queue-jumping. I find some measure of concern in that practice.
I have no axe to grind about the use of private medical care. It is obnoxious, however, that a person can be admitted to a National Health Service hospital because of clinical need and great pain but be told by the specialist at the hospital who is attending him, having obtained him that bed, "I cannot operate on you for 15 months, but if you go private I can do it very shortly."
There is something equally obnoxious in the case of a young man who had private insurance that covered his mother as an elderly person who managed to obtain treatment for her, without difficulty, in a National Health Service hospital. We may quibble about the use of a private bed in that instance, but when that insurance ran out, the specialist said, "I can no longer treat you." That is a reflection on the tension between the National Health Service and private health care.
I agree with the right hon. Member for Brent, North that where the treatment is given does not matter as long as we ensure that it is given. However, in many cases, it has not been given as it should have been.
The Eastern Health and Social Services Board has been told that the Government have said that the increase in services for Northern Ireland will be 5·3 per cent. That is 1 per cent. less than England and Wales are receiving, even though the board has made efficiency savings of 1 per cent. With a higher level of provision than England and Wales, it is discovering that it will run into greater difficulties in the coming year.
At a time when the Treasury is reporting tremendous surpluses, the House should reflect the views of the nation. The average citizen would prefer not to have his tax reduced if cutting taxes meant that the level of health care would not be maintained.

Mr. Nicholas Winterton: I am delighted to follow the hon. Member for Belfast, South (Rev. M. Smyth). He and I have campaigned politically together and as members of the Social Services Select Committee.
As has been mentioned once already during the debate, the Committee will tomorrow be taking evidence from the presidents of the three royal colleges — Messrs. Todd, Hoffenberg, and Pinker. Perhaps one of the questions that


we shall put to those three distinguished members of the medical profession is whether they believe that the doctors and consultants in the Health Service honour to the letter their contract with the Health Service. I hope that we shall receive a truthful answer, because while some members of the medical profession have been highly critical of Government — the Government have a major role to play in solving the current resourcing crisis in the Health Service — the medical profession, the doctors and consultants, have a major role to play in contributing to the solution of the problem with which the Health Service is faced.
My speech will be short. It will contain few sterile statistics, which unfortunately have been the hallmark of debates such as this and exchanges across the Dispatch Box. Having spoken to my right hon. Friend the Secretary of State, I know that he hopes that solutions to the problems, and perhaps an element of all-party agreement on some of those solutions, might be the order of the day in the future rather than trading statistics about who did what and when. While statistics were relevant in the debate last November if one is comparing what Socialist and Conservative Governments have done, this debate is not the time for trading statistics. This is the time for solutions that will help to cure the severe resourcing problems of the Health Service.
I take my responsibilities as a member of the Select Committee on Social Services extremely seriously. My uninterrupted service of some 13 years to that Committee has given me contacts with those who work within the Health Service at all levels. Those contacts have been extremely useful to me and, I hope, have given me an understanding of the problems faced by the Health Service.
Perhaps it would be appropriate at this stage and an illustration of the all-party approach if I said that the new Chairman of the Social Services Select Committee, the hon. Member for Birkenhead (Mr. Field), would normally be here wishing to participate, but he has had to attend a funeral in the West Midlands. The hon. Gentleman will be back in the House tonight but, sadly, he and I may be in different Lobbies.
I believe that the Select Committee, by undertaking its new inquiry into the resourcing of the NHS, will play a vital role in seeking to find some of the solutions to the problems facing the Health Service. Those problems are serious. I only wish that, when my right hon. Friend the Prime Minister exchanges remarks, questions and statistics with the Leader of the Opposition, she said, "We are proud of what we have done in the Health Service. We have provided more money than any other Government in the Health Service, but there are serious problems. I recognise that, but how can we solve them?"

Mr. Christopher Gill: Does my hon. Friend agree that so far in this debate there has been a presumption—evident on both sides of the Chamber—that additional funding is the only answer to the problems? Will the Committee give serious consideration to the structure and management of the Health Service?

Mr. Winterton: Certainly there is an assumption that more money is required and I must tell my hon. Friend that I intend to urge the Secretary of State—I am sorry to see that he has left his place, no doubt for just a moment — that, in the short term, the only way to solve the

severe crisis in resourcing that exists in many district health authorities is a further amount of money from central Government.
I note that my hon. Friend the Under-Secretary of State is taking prolific notes at this moment. I am seeking an assurance from the Front Bench that the necessary money will be available. I also believe that the Government should set up, as a matter of urgency, an inquiry into the long-term resourcing of the Health Service and that that inquiry should report before the end of the year. I do not believe that there should be a Royal Commission, because that would take far too long—a minimum of two years. I do not believe that the inquiries taking place within the Department will be enough to deal with the fundamental problems facing the Health Service.
As a member of the Select Committee, may I give my hon. Friend the Member for Ludlow (Mr. Gill) the catetorical assurance that the matters to which he referred — the management of the Health Service and its structure—will be part of the inquiry undertaken by the Committee. My hon. Friend's question has brought me to other matters of consideration because I believe that we must look at alternative forms of resourcing the NHS.
We should consider whether that funding would include the extension of private medical assurance and the additional involvement of the private sector in the operation of the NHS. Such involvement is already taking place to some extent in some district health authorities. We must also consider whether we should extend the contracting-out of services that are currently undertaken in-house within the NHS. We should consider further privatisation and hotel charges. I also believe that we should consider—the hon. Member for Greenwich (Mrs. Barnes) made a similar suggestion—the use of national and local lotteries to raise additional funds.
My right hon. Friend the Member for Brentford and Isleworth (Sir B. Hayhoe) spoke at some considerable length on the basis of his experience in various Government Departments. I believe that the Government must control the Treasury rather than the Treasury control the Government. If we raise extra money for the Health Service I believe that it is wrong that the Treasury should automatically deduct that sum from the money that it would otherwise give towards the running of the NHS. I hope that the Chancellor and other Ministers are of the right calibre and competence to counter any such activity at the Treasury.

Mr. Ian Taylor: When the Select Committee is considering this problem, will it also take into account the attitude of the Treasury to splitting out a tax charge as part of the tax system? I hope that my hon. Friend would agree that, if we continue with a tax-based financing of the NHS, it remains almost impossible for the public to understand what it is that they are contributing to health care.

Mr. Winterton: I am delighted to have the opportunity to answer that question. Perhaps I could refer my hon. Friend to an excellent article that appered in the Sunday Telegraph on 17 January. A five-nation survey was undertaken and reports were produced on Germany, France, Russia, America, Italy and the United Kingdom. Mention was also made of New Zealand. In the introduction to the survey, Martin Ivens said:
Like Britain, New Zealand is one of the few countries to pay public hospitals for their costs, not what they actually do. An official report to be published soon"—


in New Zealand, I understand—
is expected to recommend privatising the hospitals and making patients pay for treatment.
I am not suggesting such a policy for the United Kingdom because I remain convinced that, in the main, the NHS should be free at the point of delivery—it is not free as such, because we pay for it in taxation and other ways.
May I pick up a point made by my right hon. Friend the Member for Brent, North (Sir R. Boyson)? I do not go along with many of the things that my right hon. Friend said about marketing the NHS and denationalising the Health Service. However, my right hon. Friend did warn the Front Bench—we should take note of such warning — that the Health Service is the Achilles heel of the Government. Indeed, to pick up an expression that my right hon. Friend used, the Health Service could become the albatross for the Government unless we are seen not only to understand the problems, but also to tackle them in a meaningful way.
I hope that my suggestions will come out in the recommendations from the Select Committee. Indeed, we will be producing interim reports because we are undertaking a major inquiry into the NHS. We must provide additional resources for the NHS.
The hon. Member for Manchester, Central (Mr. Litherland) spoke with great passion about the Manchester royal infirmary. I have a number of constituents who are consultants at that hospital. I have visited the MRI in a private capacity; otherwise I would have notified the hon. Gentleman, and have spoken not only to the management, but to some of the leading consultants. That hospital faces a serious crisis in resources and it must be tackled by Government. The Under-Secretary may turn away in disgust at what I have said, but I assure her that there is a crisis.

The Parliamentary Under-Secretary of State for Health and Social Security (Mrs. Edwina Currie): I am noting down what my hon. Friend says.

Mr. Winterton: I am glad that some of what I have said is being noted.
The MRI is a centre of excellence and a leading teaching hospital in the centre of Manchester and part of the central Manchester health district, which is part of the North Western regional health authority. Its catchment area is relatively small. However, that hospital draws in from a wide area because it is a teaching hospital and a centre of excellence. I believe that the Government must pay special attention to hospitals such as that.
I believe that the Government mean what they say when they speak of value for money. Can it be right that in the Macclesfield district health authority an expensive and excellently equipped first phase of a district general hospital, costing some £18 million, should have two of its important acute wards closed at this time? Is that value for money? Is that bringing a return on the substantial capital investment? No, it is not.
However, there is more that is wrong. The consultants have been co-operating with the management of that district to bring about the savings that the Government have urged all district health authorities to make, but is it right that the management should say to those consultants that they must reduce their theatre sessions? Are they

going to go out on the golf course or undertake more private practice? I urge them to fulfil their National Health Service contracts to the letter. However, what happens if they cannot fulfil their NHS contracts to the letter because, for example, they cannot use the operating theatre to carry out the operations for which there are waiting lists? The Government did well on waiting lists until last October when the crisis developed. Waiting lists, which were falling, are now beginning to increase again. That is a very serious matter.
I pay tribute to my right hon. Friend the Minister for Health, who met a delegation led by me just before Christmas. He heard at first hand of some of the problems with Macclesfield health district. In spite of what the media and some hon. Members say, the problems facing the Health Service have arisen not because of cuts but because of the Health Service's outstanding success. It is because of the success of the managers — following Griffiths — consultants, doctors, nurses and all NHS staff. Medical techniques have advanced so fast in recent years that we can now carry out operations that were mere pipe dreams a year or two ago. We are now treating more patients in our hospitals. The replacement of joints—not just hips but ankles, knees, elbows and wrists—is now possible but the operations cost a great deal.
The Health Service is precious to all the people of this country and to most Conservative Members. I urge the Government not only to provide a further sum to help the Health Service through the present crisis but to set up an urgent inquiry into the long-term resourcing of the Health Service so that we can continue to be proud of the finest health service in the world.

Mr. Eddie Loyden: I listened carefully to the remarks of the hon. Member for Macclesfield (Mr. Winterton). It is encouraging to note that there are Conservative Members who recognise the value of the Health Service.
It is important that we should remind ourselves that the legislation that brought the Health Service into being in 1948, introduced by the then Labour Government, was probably the most progressive for many years. In that respect, it may not have been superseded since. Like other hon. Members, I can remember when there was no National Health Service and compare the health care of the pre-war period with that following 1948, when the Health Service was established. It is because they are able to make such comparisons that people outside the House recognise the importance of the Health Service and are prepared to defend it at all costs. That is why there has been such an outcry from the public at large. As they see it, and indeed as we perceive it, the recent deterioration in the National Health Service has reached crisis proportions.
The establishment of the Health Service largely ended the appalling and unacceptable pre-war divisions in the administering of health care. We must remember how the working classes were treated during that period. The poverty of the working classes and the environment in which they lived resulted in almost daily visits by hearses, arriving to carry away young children or their mothers or fathers. The life expectancy of such people was drastically shortened because the conditions that prevailed caused widespread and serious disease and illnesses. We saw the


great value of the Health Service and the benefits that accrued from it when we watched the first generation of post-war babies growing up.
Especially after having listened to the Secretary of State this afternoon, Opposition Members are concerned at the way in which statistics have been to the fore in our debates on the National Health Service. Those outside the House who are worried about the Health Service are not concerned about the accusations or statistics that have been bandied about every time that the NHS has been debated in this House — particularly by the Prime Minister, who has ignored Opposition, and sometimes Conservative, warnings that the statistics disguised the reality at the coal face of the National Health Service.
Many hon. Members are more sensitive about this subject than they were, because there have been clear signs of the decline in standards in the areas that they represent. That decline cannot be measured by statistics. It is seen in the number of people waiting for hospital treatment, in the number of beds that have been withdrawn, in the closures and in a whole range of factors which are recognisable and which have been identified by patients and their families —those who are directly involved. They know about the decline in the National Health Service.
I do not want to bandy statistics around to verify the argument that the crisis exists. I am glad that the hon. Member for Macclesfield recognised that the Health Service is a regime. That regime includes people who may not be directly associated with medical care but who are as necessary as nurses, doctors and other hospital staff. It includes those who provide patient care in other ways—who keep our hospitals clean or provide direct services to hospitals. Frankly, those people have been treated most callously by this Government, with the result that this concept of patient care has changed. Patient care must include the role of the person who pushes the trolley that takes patients to the treatment room.
Let me give an example from my constituency. An 83-year-old woman waited for three and a half hours to be moved to the place where the ambulance would pick her up. That is one of many examples of the stresses unnecessarily caused to patients and arising from the changes that have taken place among ancillary staffs in hospitals. whose role is as important as the role of anyone else in the hospital. It is paramount that we should view the Health Service as a total regime. The decline started with the privatisation of cleaning and other services, which has left a bad taste in most people's mouths and has led to a deterioration of standards.
Those of us who sought the establishment of the Health Service saw the great benefits that derived from it. Opposition Members recognise the importance of the steps taken to end the scandalously poor health care available to hundreds of thousands, if not millions, of people in this country. The first post-war generation exerted pressure on the Government and made it clear that they were not prepared to return to local authority hospitals. It is ironic that Conservative Members should argue for a return of the control of hospitals to the local authorities, while at the same time slashing local authority funding. When hospitals were under local authority and charitable control, the care given most people was of a very low standard indeed. We all have a responsibility to ensure that that legislation that transformed the health care of people in this country, which, quite frankly, has been in decline for several years, must be arrested.
Statistics cannot alter the fact that there is a wide-ranging crisis in the National Health Service which needs to be tackled now, not in a year or two or later, following inquiries. The Government must respond to what is happening. They must recognise that people are waiting for treatment but not getting it; that people have been moved out of hospital too quickly, only to return, and that many people, especially old people, are waiting for cataract operations that they cannot have for the next 18 months or two years. My wife attended Clatterbridge hospital as a cancer sufferer. She was turned back five times because the machines were not functioning. That is the state that the National Health Service has got into over the years.
I hope that this debate will not be meaningless but that the Secretary of State will take it on board. I hope that it will end the jargon of statistics and that the Government will recognise the reality of the situation in the Health Service and the fact that it needs immediate and urgent attention—which means funding to ensure that people who are waiting for treatment get that treatment. The Government should ensure that hospital services are brought back to the standards that those who established it envisaged, not only for that time but for the future. It was envisaged that there would be constant improvements, rather than constant decline, in the National Health Service.
We believe that the National Health Service is not only worth defending, but that standards should rise. We should ensure the standard of health care to which our people are entitled. I advise Conservative Members that the most important investment that any country can make in its people is the investment in their health care. Without that, all else is meaningless. One cannot achieve production or the type of society that one wants if one does not provide the Health Service and health care that the people of this country need.

Mr. Roger King: The city of Birmingham and, I suppose, the West Midlands regional health authority have been much in the news recently for various reasons, which centre, possibly almost exclusively, on the role of the Birmingham children's hospital.
It was apposite of my right hon. Friend the Secretary of State to say in his opening speech that much has been achieved by the Health Service during the past nine years under the Conservative Government. Indeed, a great deal of evidence is available in Birmingham and the west midlands to support that achievement. We can boast of many successes in terms of extra doctors and nurses and the number of family doctors has increased during the past few years. There has also been a reduction in the child death rate and in the number of stillborn births.
In Birmingham the improvement that has been brought about by the £4 million reduction in costs has meant that that sum is available for improving patient care. The number of staff has increased. In Birmingham, for example, the hospitals now employ over 800 more nurses than in 1979. The statistics are fairly substantial and most people, whatever their view, would accept that an enormous amount has been achieved since 1979. The trouble is that politicians jump on certain bandwagons to try to point out and identify areas in which there are problems.
The Birmingham children's hospital does have problems. It does not have its full complement of nurses for intensive care. Such nurses are not available, despite national advertising. Training such nurses takes time and there is nowhere else, outside London, where such training takes place. The West Midlands regional health authority has taken the initiative and is to start to train its own nurses in the hope that out of the 12 who start to train shortly, provided agreement can be reached with the nursing unions, most will stay in the west midlands area and at the Birmingham children's hospital.
Operating on young children is not a straightforward task. One cannot simply say that on 25 February one will give a certain child a major operation on his or her heart. Whether the operation takes place is dependent on the state of the child when the operation day arrives. The child may not be well enough to take the difficult and intricate operations that are carried out at that hospital.
Some of the publicity during the past few weeks has perhaps put hospital staff under tremendous pressure when making decisions which may not always be in the interests of the child, but are certainly in the interests of responding to widespread public feeling. The decision to operate is difficult for consultants and it is not pleasant for them to see television cameras and news reporters outside the children's hospital waiting for the latest crisis to emerge.
It is not helpful for Members of Parliament to place great emphasis on the problems in their community. I draw attention to the outrage that occurred in this House during prayers on the first day that we were back when the hon. Member for Coventry, North-East (Mr. Hughes) made a great crusade. Obviously he felt strongly about a child, presumably in his constituency, who was being denied an operation. It was a life and death situation. One would have hoped that the hon. Gentleman might have been present today to give us further background on his problems and that he would not have had recourse to such cheap publicity. As my right hon. Friend the Prime Minister said during Question Time this afternoon, the consultant of the child in question does not want to operate for another 12 months or so. That decision has been made to ensure that the child stands a good chance of recovering from a difficult operation when he or she has the strength to undergo it, not when a politician demands it. We are owed an explanation by that Member of Parliament.

Mr. David Winnick: rose—

Mr. King: No, I shall not give way. Time is pressing and other colleagues want to have a say, so I must get on.
When one considers the funding of the National Health Service, there are obvious opportunities to improve the resources available to the Health Service. We want to know where our money is going. We want to be absolutely certain that a pound that is given to the Health Service is a pound that is spent on hospital and patient care. Arguments are made about tax cuts versus extra resources for the Health Service. We need to be reminded that 1 million people work for the Health Service. Unfortunately, those people usually receive a low income. I am certain that they benefit enormously from the tax cuts that we have given during the past few years and that they will benefit again when my right hon. Friend the Chancellor

has his say at Budget time. It is right to point that out because Opposition Members are always saying that Health Service workers receive low pay. However, when the Government try to bring their pay up to an acceptable level, using the mechanism of tax cuts, that is not acceptable either.
I recently appeared on the Kilroy-Silk programme from an excellent private hospital in Birmingham to talk about the problems of the NHS. Following that programme, a mother who was having difficulty obtaining an operation for her child asked me, "Where has all the money gone for the Health Service?" I explained to her that we were putting record sums of money into the Health Service. I told her that she was in a building that had been created because of resources that had been taken out of the Health Service because private patient treatment used to be part of the National Health Service responsibility many years ago. Those private patients were thrown out of the National Health Service as a result of doctrinaire decisions by the then Labour Government. Their money has gone into the creation of new private hospitals. Therefore, to a large extent, many of the resources that the Health Service used to have have gone elsewhere, to the detriment of the Health Service.

Miss Mowlam: rose—

Mr. King: I repeat that time is pressing and many hon. Members wish to speak, so I must get on.
The concept of free health, as we have understood it since 1948, when disposable incomes were non-existent because people had a job to house, feed and clothe themselves, is inapplicable now. They could not decide to have a new car or a continental holiday or anything else like that. Therefore, a free Health Service at the point of receipt was well received at the time. However, things have changed. Although we need extra resources in the Health Service, I want those resources to be bought by the prospective patients themselves. National insurance contributions could be reduced by a significant amount, provided that we established the principle that those who could afford it—not those of pensionable age, those on low incomes and the unemployed — would pay 50 per cent. towards the cost of their operations.
What would those people do in turn? To guarantee that they did not pay the 50 per cent., they would take out an insurance policy. And who would offer the best insurance policies? I hope that the hospitals themselves would offer competitive opportunities and treatments to patients in their areas and regions. I see no reason why such a system could not be introduced.
We should also look at reorganisation of the Health Service. To a degree, the service is too closely attached to this Parliament. Perhaps we should look at a British health corporation, which could operate at arm's length, and whose board and chairman could be given the money and told to get on with the job of running the Health Service.
I also believe that some of our specialist hospitals, which are wrapped up in the general morass of the Health Service — examples are the Birmingham children's hospital, the Queen Elizabeth hospital, the orthopaedic hospital at Oswestry and the Great Ormond street hospital — could be taken out of the existing organisation of areas, regions or districts in which they now operate, and put under a single national hospital organisation. An organisation of hospitals of excellence could well extract


a substantial income from voluntary contributions through a national lottery. The trouble with a national lottery is that the £100 million or so that it would raise for the National Health Service would go a very short way to providing extra services all over the country. However, if the resources went only to hospitals of excellence, they would go a substantial way.
The challenge that now faces us is neither an Achilles heel nor an albatross around our necks. It is an exciting opportunity for us to get the Health Service right. We need to start a series of debates such as this, in which we can debate new ideas and exchange our visions of the future.
We are not talking about updating the service, or reverting to 1948. We are planning for a Health Service for the year 2000 and for the next century. This debate should form the groundwork for a national debate on what future structure the Health Service should take. It is a great challenge for the Government.

Mr. Dennis Turner: It is said that we live in hope and die in despair. I further despair after listening to the hon. Member for Birmingham, Northfield (Mr. King). What he said shows clearly the dilemma faced by the Government and their supporters in their attitude to, and philosophy on, the National Health Service.
The hon. Member for Northfield demonstrated, to me at least, that he is echoing one of the views of the Conservative party that is the most worrying to people in this country who cherish the National Health Service and wish us to address ourselves to the problems that it faces, not to misrepresent the difficulties of sick people who should be receiving our attention tonight.
Since I was elected in June, rather than thinking in party-political terms, I have sought to represent the interests of the people of Wolverhampton and the west midlands in facing up to our health problems. In my maiden speech, I mentioned that, in the last few weeks before the general election, 85 people in Wolverhampton had been turned away from hospitals in the town. I also said—and it was not challenged, then or subsequently, by the Minister—that we had lost £3.9 million from our budget since 1983. A more local issue, but a very deeply felt and sensitive one, was the reduction by 50 per cent. of the provision of incontinence pads for the elderly and the disabled.
On 7 December, I was kindly allowed to contribute to the debate on the Health and Medicines Bill. I was able then to illustrate the problems that faced Wolverhampton by pointing out that three people had died in recent weeks as a result of not being admitted to hospital, because no beds were available. Four hundred people had been refused admission, although, again, they were seriously ill. I also pointed out that we were experiencing considerable difficulties with the temporary renal unit, which could not meet the needs of kidney patients.
The Under-Secretary of State, the hon. Member for Derbyshire, South (Mrs. Currie), was present at that debate on 7 December; indeed, she wound up for the Government. She did not challenge the point that I made, although she had the opportunity to do so.

Miss Mowlam: The hon. Lady is not even listening now.

Mr. Turner: I do not believe that she was listening when I spoke last time. Perhaps there is something wrong with

me. I do not know. However, my voice is coming across more clearly tonight. In any case, I shall continue, even if the Minister is not listening.
One can imagine how people in Wolverhampton, felt. In contrast to the argument that, while we know that things are bad, they are getting better, I am trying to illustrate that, in Wolverhampton, things are getting worse. I know that we have certain views about the accuracy of the press; however, on one occasion the press reporting was accurate. Let me give the House a picture of developments in our hospital service during the Christmas period. First we saw:
114 more beds to close".
They were at the Royal and New Cross hospitals. Next, we read:
All admissions to town's hospitals temporarily suspended".
Patients threaten to chain themselves to beds to prevent closure.
Surgeons in scathing attack on Heath Service funding".
The hon. Member for Northfield talked about Birmingham, and said that the focus was on the children's hospital. No doubt he saw the headline announcing that 18 cancer sufferers at the Queen Elizabeth hospital had died as a result of not being able to receive the treatment that they needed. We met many parents and little children yesterday whom the Prime Minister did not see. We have seen the cases of David Barber and Matthew Collier, and we are all very pleased—

Mr. Winnick: In view of what was said by the hon. Member for Birmingham, Northfield (Mr. King), does my hon. Friend agree that the reason that my constituents Mr. and Mrs. Collier went public was that the child was given an appointment—not admission—only at the end of February? The only reason that he was not admitted was that there were no beds available. It was agreed that Matthew should have an operation as quickly as possible and, in those circumstances, the parents decided that there was no alternative but to go public. They were right to do so. If I was of any assistance, I am very pleased I hope, as we all do, that Matthew will recover fully and will live a long life. As to the Queen Elizabeth hospital, is he aware that when I visited the hospital on the same day two weeks ago that I visited the children's hospital, I was told that 27 beds in the section dealing with cancer patients had been closed last year?

Mr. Turner: My hon. Friend has made a valid point, that the problem in both hospitals is a shortage of beds. Wolverhampton hospitals in all the acute specialties, with the exception of ophthalmics, are short of beds. As I said on 7 December, in some cases the shortage is as great as 50 per cent. The case has been made for Birmingham as it has been for Wolverhampton.
The Department belatedly and reluctantly responded to the crisis by giving the non-recurring £700 million, which we were told was equivalent to £6·7 million for the west midlands and £200,000 for Wolverhampton, which will have to meet a deficit of £650,000 by 31 March. How can that contribution of £200,000 be reconciled to the crisis that we will face at 31 March and, indeed, the impossible task of meeting the 1 per cent. efficiency demands that apparently will be made for 1988–89?
There is non-reality about where we are moving in 1988. We can see no hope, only despair, for the people we represent in Wolverhampton. It is not a party-political issue. We are stating the case on behalf of the people that


we care about. The greatest contribution that the Minister could make for the Government would be to give us a full and total commitment to the principles and values of a national, centrally-funded Health Service available to all at the point of need. We should start to restore the faith and confidence of all who work in the Health Service. We should acknowledge properly their skills and ability. Further, we need at least £1 billion to begin the process of putting the heart back into our National Health Service.

Mr. Robert McCrindle: My basic approach to the debate is that there are no simple solutions to the dilemma in which we find ourselves in the National Health Service. Anyone who speaks to the contrary is misleading the people whom we represent. There is certainly no point in pouring funds in without a real understanding of the nature of the problems that confront us. I was struck by the fact that the hon. Member for Livingston (Mr. Cook) talked about nothing else but the need to provide additional funds. Many of us would concede that that has a part to play in solving the problems, but to say that that alone is the matter to which we should turn our attention is wholly misleading.
I find it equally unacceptable to contemplate what I think my right hon. Friend the Member for Brent, North (Sir R. Boyson) calls the privatisation of the National Health Service if by that he means the selling of hospitals and the provision of health vouchers to the population. That is unacceptable, although it is different altogether from saying that I am other than a firm supporter of the private sector in health care. I want to see that expanding and playing a more vital role in total health provision. Apart from believing that the proposals of my right hon. Friend the Member for Brent, North are politically unsaleable, I believe that in 1988—things may change in the years ahead—the majority of the people continue to support a National Health Service which is funded predominantly by taxation. I repeat that that is different from saying that there is no argument for additional sources, but I do not believe that we should lose sight of the fact that the National Health Service as we have known it for 40 years remains basically acceptable to the vast majority of people.
As in most things, the likeliest solution to the problems of the NHS may lie in what I shall probably be ridiculed for calling the middle way. That means that sufficient funds must be made available in the short term but that Her Majesty's Government must simultaneously take a grip on the many administrative difficulties which in turn may require the establishment of a swift, meaningful examination by an impartial body. I listened with interest to the suggestion of my hon. Friend the Member for Macclesfield (Mr. Winterton). He is correct in saying that we do not need a Royal Commission, but I am less persuaded about whether we can be so certain that we understand all the basic administrative problems.
I suspect that sufficient funds are available — they have already been allocated — but there are two immediate areas of concern to which the Government should pay attention and for which funds must be provided, if they are not available, within the additional sums that will come forth in the next financial year—a point, incidentally, to which very few hon. Members have

paid attention. We keep pressing for more expenditure in the next financial year without recognising that we already know that a substantial amount of additional health expenditure will be forthcoming as a result of the Autumn Statement.
The Government must accept that if there is a nurses' pay award in the next few months at the same level, say, as that for last year of 8 per cent., they must pay that 8 per cent. They must not accept the award and pass on half of the responsibility for meeting it to regional health authorities. If they do that this year, as happened last year, the additional 4 per cent. which will have to come from existing budgets can be found only by a reduction in patient care. We should not countenance that.
There is a strong case for the restructuring of nurses' pay so as to provide incentives to attract people into those specialties where, as the popular press has been telling us over the past few weeks, there is an acute shortage.
In the short term, there is also a strong argument for again targeting a limited amount of funds at the reduction of waiting lists. The success of last year's efforts, with minimal resources, was such that I recommend to my hon. Friend the Under-Secretary of State that further consideration be given this time, not to targeting waiting lists in general, but to taking note that in some parts of the country the waiting lists for kidney and cataract operations are in all conscience far too long. Whether on this occasion we should target the additional resources not to waiting lists as such but to the ailments in respect of which we know there are long waiting lists is worthy of exploration.
Beyond that, additional funds may still be required. That will be so only after we have cleared our own minds as to exactly where money is required. I repeat that there is no advantage in saying indiscriminately that we should invest more in the Health Service without being clear as to the reasons why the Health Service is in difficulty.
Let me give the House some examples of the questions I believe must be answered before we have a clear idea of the direction of additional funds. Why, for example, is there such a disparity in the efficiency of district health authorities? Why are waiting lists in one area so different from waiting lists in another? It cannot be purely accidental. Is bed management better in some areas? Are there bed managers in some areas but not in others, and should they be a requirement? Do we need—dare I say it in quite basic terms that I know will provoke some people outside the House—regional health authorities at all? We seem to have survived perfectly well without area health authorities, which were considered to be essential before 1974.
What future role is there for the private sector? Should there not be more cross-fertilisation with the NHS, and should we not have more choice within the NHS with the development of an internal market? We need answers to all these questions, but they need not necessarily require additional resources. If the answers to these points require more money, then I would willingly go along with that. This is again a personal viewpoint, but I would willingly forgo some of the tax cuts to which we can look forward, if that is the way to achieve it. I believe that we can achieve desirable tax cuts and the desirable increase in expenditure necessary for the Health Service.
What we must not do is convince ourselves that all that is needed is to throw money at the problem. We must first


establish priorities. Again I say to my hon. Friend the Under-Secretary of State that there seem to be a myriad of inquiries within the Department of Health and Social Security, and within health regions and health districts. It is high time that there was some co-ordination of all these inquiries. Indeed, if I were to send just one message to the Secretary of State, it would be that it is time for him to take a grip of the National Health Service, and no longer to be pushed around and fobbed off by some of the representations made in recent months by the health regions and districts and by trades unions. If in the process he can come close to taming the bureaucratic monster, as my hon. Friend the Member for Wokingham (Mr. Redwood) has rightly described it, so much the better.
I should like to add some random final thoughts. The blood transfusion service, a main centre of which is in my constituency at Brentwood, provides and has provided in the past a great service to the people of this country. I was alarmed to notice, however, during the recent King's Cross disaster that we only just managed to cope with what was by some measurements a fairly small disaster. I wonder whether there is a case, as I see suggested in the press today, for greater centralisation of the supply of blood so that we can co-ordinate it to a greater extent and make sure in the event of such disasters that there is never a suggestion of a shortage of these necessary supplies.

Mrs. Currie: I hesitate to interrupt the excellent flow of my hon. Friend the Member for Brentwood and Ongar (Mr. McCrindle). I have been listening to him with great interest. As he knows, I attended the hospitals on the night of the King's Cross disaster, and I was repeatedly assured that there was no problem with the supply of blood. The patients there did not require blood; their problem was that, because they were burnt, they needed albumin. That is a highly specialised material which tends to be produced only on demand in small quantities. That is why the hospitals had to call for the material from Scotland. I was never at any time told that there was a problem with the supply of blood.

Mr. McCrindle: My hon. Friend had the advantage of being there, and I have had to rely on press reports, which I hope she has seen in the past few days. They show that my point was valid, but if it was not I am happy to withdraw it.
I do not think my hon. Friend's remarks invalidate what I have said — that, while the blood transfusion service has done a lot for the country in the past few years, there is perhaps a case for seeing whether greater centralisation is called for.
Another hobby horse to which I must turn my attention is the funding for the Thames regional health authority. It is high time that RAWP was overhauled. When it was introduced, many of us were prepared to accept that our level of provision was good, whereas that was not the case in Liverpool, Huddersfield or Manchester. With the greatest respect, and bearing in mind that my hon. Friend the Minister represents a Derbyshire constituency, I say that we are now suffering after several years of the operation of RAWP. I also remind the Minister that the former Secretary of State for Social Services promised me in October 1986 that a report would shortly be received concerning the revision of RAWP. So far, that report does not seem to be forthcoming. It is an inordinately long time

to wait, and the level of patient care has become endangered as a result of the progressive funding of other parts of the country in preference to the Thames region.
I do not suggest for one moment that we should cut the provision that we make for other parts of the country, but if it means that we need additional resources so that the four Thames regions can obtain some advantage, then. I would have to say to my hon. Friend that it is high time consideration was given to that.
I repeat my fundamental conviction that more funds are required in the short term, but much more besides is required if we are to reshape our National Health Service to meet the requirements of 1988. It is crucial to recognise that. If more funds are needed, then so he it, because having willed the end we must will the means.

Mr. David Hinchliffe: One of my hon. Friends, who unfortunately is not in the Chamber now. refers to the "clockwork parrot" from Downing street who appears twice weekly to churn out endless cold statistics. I prefer to regard her as a heartless, aged ostrich who comes here, with her head in the sand, denying the facts that are presented to her daily about what is happening in the National Health Service under the present Government.
The vital issue in the debate is how to get the Government to accept what is happening throughout this land at local level to the National Health Service. I shall refer briefly, Mr. Deputy Speaker—I appreciate the need to be brief— to the situation that prevails in my constituency, and the difficulty that I have experienced in getting a response from the Government.
I am passed from the district health authority to the regional health authority, and from that authority to the Government. The Government blame the DHA and the RHA. It is a buck-passing exercise second to none, certainly in my area, and, I have no doubt, elsewhere in the country.
On 11 September, I wrote a six-page letter to the Under-Secretary, who never listens when I am speaking—I am sick and tired of addressing the hon. Lady who constantly and deliberately ignores the points I am making. I wrote in September a six-page letter about the cuts package that affected people in my constituency. I saw the hon. Lady subsequently and she promised to reply to me. I had a letter back on 5 October referring to what she called "the proposed changes" in health services in Wakefield. not the fact that the Health Service was being systematically run down before my very eyes.
On 26 November we had a debate in the House, and I was told off for speaking too long. I spoke for about 20 minutes detailing the situation facing my constituents. I should like to remind the House of those points, because the situation has not changed. If anything, it is worse. We are talking about the closure and sell-off of Snapethorpe hospital, the most modern hospital in my constituency, and the failure to open a ward at Clayton hospital. Earlier this week, I did receive an answer from the Minister, saying that it was nothing to do with her. The authority cannot open the ward, which has had thousands of pounds spent on it in an improvement programme, because it cannot afford the staff.
We have also seen the introduction of an allegedly unsafe cook-chill system of catering, again to bring about


a saving with the local health service. Within the past year, 38 acute beds have been closed when there is a 25 per cent. increase in the waiting list for these beds.
When the cuts package was agreed, the consultant representative on the health authority said that, quite clearly, that action would increase morbidity and mortality rates. That will affect my constituents.
I had no response from the Minister to the points that I made in a 20-minute speech. There was not one comment from the Minister in her wind-up at half-past nine. I went up to her afterwards in front of the Prime Minister, and she will recall that I asked her why she had not responded to my problems in Wakefield. She said that she had not got enough time to respond.
So I wrote to her on 3 December asking for detailed responses to the points I had made about the problems in my health service in Wakefield. I have had no response six weeks later—not one letter back from her about the situation we are facing in the health authority in my area. Since the last debate, we have had an additional allocation of some £4·7 million to the Yorkshire regional health authority, but I have made the point to the hon. Lady in the Health and Medicines Bill Committee that that will not even restore the cuts that have been agreed in my health authority during the last few years directly as a result of Government underfunding.
My hon. Friend the Member for Livingston (Mr. Cook) made the point that there has been a directive for a further 1 per cent. reduction in health services within the Yorkshire region. I understand that it was prised out of the general manager of the Wakefield health authority at the last meeting—the chairman was not aware of it—and that it is a directive to make a further 2 per cent. reduction in the present year's allocation within the local health service.
I want answers tonight. I want to know from the Minister why she has since September refused to respond to the problems that my constituents face about the rundown of the National Health Service in Wakefield. I should also like to know why she refuses to meet the leader of the Wakefield metropolitan council to discuss the clear implications for the council of the cuts and closures that have been agreed by the Wakefield health authority. The Wakefield council estimates that these cuts and closures in the acute sector and in other parts of the health service in Wakefield will mean that it will have to spend an additional £529,000 on the provision of community care, on top of home helps and that sort of thing, to cover the problems arising from the cuts in the National Health Service.
Having referred to the local issues that directly concern me — I hope that I shall get some response from the Minister today—I think that it is even more important that we look at what the Government's real agenda is for the National Health Service. I am delighted to have sat through about five hours of different speeches, because it has given me the opportunity to hear at first hand the real agenda of the Tory party.
I listened to the right hon. Members for Chingford (Mr. Tebbit) and for Brent, North (Sir R. Boyson), and it is quite clear that the real intention of the Tory party is to transform the solid and, I am proud to say, Socialist values of the National Health Service into a free market, with the buying and selling of health care as a commodity. Quite

clearly, that is the intention of the Government, and the cuts are a deliberate attempt to force people into the private sector. Increasingly, people are meekly accepting the need to bribe—I use that word because I think that it is the only explanation of the action—a consultant to treat them, to enable them to jump the Health Service queue. That is the kind of situation that Government Members want, because they want deliberately to create an expectation of paying for treatment, prior to the wholesale changes in the Health Service that they intend to generate before very long.
I want to digress to raise one small personal issue which I was reminded of when the Secretary of State, in attempting to defend his period of time in a private hospital prior to Christmas, referred to the fact that his mother, when she was dying of cancer, was treated in a National Health Service hospital. I had the experience of my father waiting for a year for admission for a serious heart operation to Killingbeck hospital in Leeds. When he got into hospital, he was dying, and the bloke in the bed next to him told me that he had exactly the same problem as my father but had got into hospital within six weeks because he had paid. Where is the morality in that kind of situation?
When I hear the right hon. Member for Brent, North talking about competitive enterprise, that is the kind of situation that I look at. What happens to mentally handicapped people, physically handicapped people and chronically ill people, those whom insurance companies will not touch with a bargepole, under this great new system? He has forgotten about them, and he could not care less about them.

Sir Rhodes Boyson: rose—

Mr. Hinchliffe: No. I will return the compliment; I will not give way either.
The Secretary of State said that all the Opposition call for is more money, and I do not think that that is fair or true. We ask for an honest response on what is actually happening within the National Health Service. We ask for a Secretary of State and a Government who use the National Health Service, not the bunch of selfish queue-jumpers that we face in the mob across the Floor. We ask for a return to a commitment to the underlying principle of the National Health Service, the right to treatment regardless of individual ability to pay.
When are we going to get some answers to those points about Wakefield and the wider points that I have raised in the debate tonight?

Mr. Sydney Chapman: Inevitably, but rightly, as the hon. Member for Wakefield (Mr. Hinchliffe) has reminded us, Back Benchers use these occasions to raise constituency anxieties relating to the issues being debated. I intend to be no exception to that great parliamentary tradition tonight, not least because last Friday it was announced that the local maternity hospital just round the corner from where I live in my constituency was to close temporarily at the end of this month— not because of lack of funds but simply because there are insufficient properly qualified staff to give that hospital the attention it needs.
I think that it would be quite wrong to talk about these problems without mentioning that we are discussing these


matters in the context of the Government's having provided significant extra resources to our National Health Service. They have done that, at least over the last eight years, not in finance alone. There are many thousands more nurses working in the Health Service, and we needed thousands more, because we cut their working week from 40 to 37½ hours. There are 13,000 more doctors and dentists working in the NHS. We are treating many millions more patients a year than in 1978. About 240 major capital building programmes have been completed, having been planned by this Government, and another 100-plus are in the pipeline, and the news is good.
The twin problems and the twin challenges facing the National Health Service are these: that demand is escalating, and demand always will escalate; and that one of the causes of that is that new treatments are being devised and expensive new prescriptions and drugs are being introduced. These are the problems we face, but they arise from the success of the National Health Service, not in any way from its failure.
One other thing must be said: we have increased NHS expenditure, which is now running at £21,000 million a year. That is an increase, as many hon. Members have said, in real resources of almost one third in the last eight years. It is incumbent on the Government to continue to increase those resources, as they have patently done in the last eight years, and to ensure that they are used in the most effective way. We are discussing a level of expenditure on the Health Service which represents £375 per year for every man, woman and child in our country.
One of the problems that we face in the Barnet health authority area is a shortage of nurses. I want to spell out precisely why this situation has arisen. If the Government increase the resources to our Health Service by, say, 2 per cent. a year in real terms, under the RAWP formula, to which my hon. Friend the Member for Brentwood and Ongar (Mr. McCrindle) referred, the London regions receive only 0 per cent. to 1 per cent. Health authorities such as Barnet, which was perceived to be the third most over-endowed district health authority in the most over-endowed regional health authority, usually receives minus 1 per cent. to 2 per cent. That is the situation this year. The latest figure for cash revenue limits for Barnet health authority in this financial year, which I got from the general manager this morning, is about £70 million. In 1986–87, it was about £68·5 million. That is an increase of 2·6 per cent., but there has been an inflation rate of about 4 per cent. to 4–5 per cent.

Mr. Corbyn: Will the hon. Gentleman give way?

Mr. Chapman: No, I shall not give way because we are up against time and I have been here for every minute of the debate.
In real terms, therefore, we are suffering a loss of almost 2 per cent. Seventy-five per cent. of the budget goes in wages and salaries, but wages and salaries have increased by much more then 2·6 per cent. Many NHS employees will say that they have not increased sufficiently, but they have gone up considerably more than 2·6 per cent. Barnet has had to cut not the number of nurses—they have left for other reasons — but some patient services. That situation cannot continue year after year.
We must have a more intelligent system for dealing with this problem. Barnet health authority is short of the equivalent of 200 full-time nurses. It is Catch 22, because

the nurses cannot be recruited, even if the local health authority could afford to have them, because of the high housing and other costs of living in the area. I am aware that there is a London weighting allowance for nurses of £930 per annum, but I remind my hon. Friend the Minister that the major clearing banks in London pay a weighting allowance to their staff of about £3,000 a year. Nurses leave for other jobs which pay comparatively better and they leave the area because they cannot afford the housing costs.
I apologise for having gone on so long about that point, but it is crucial to the future successful working of Barnet health authority. There are 191 district health authority areas in England. We must have, if not differential pay according to area, a much more sensitive and sensible London weighting allowance. The present system is anachronistic and inadequate. The litmus test is quite simply that the matter is urgent. I hope very much that the Victoria maternity hospital will reopen in April after it has to close at the end of this month. It can do, if Ministers grapple with this problem now.
I look forward with confidence to my right hon. and hon. Friends on the Treasury Bench dealing with this matter and helping to continue the great and undoubted progress that we have made in the National Health Service in Barnet and other parts of the country.

Ms. Joan Walley: The only reason for today's debate is the severe crisis in the National Health Service. It affects just about every constituency of every hon. Member who has spoken in the debate.
People are dying who need not die. People who know them and their families and live with them in their communities feel strongly that people are dying who need not be dying. They feel helpless. I blame the Government for not making available to the NHS some of the extra money that we know to be available.
We are also here today because, against their better judgment, people have had to resort to publicity as the only way to get something done.
They do not like doing that. They find it distasteful. But those of us who represent constituents who have not been able to obtain health care have chosen the crisis in the NHS as the subject for debate because we want reestablished the principle that health and treatment should be available to everybody through the promotion of good health and through a National Health Service which provides treatment for people when they need it rather than because they can afford to pay for it.
We are here today also because of the many dedicated staff throughout Britain who work at all levels in NHS hospitals, whether as nurses, ancillary workers or highly-paid consultants. They feel that it is about time that what is happening in their daily work experience is exposed to the general public. They cannot tolerate the working conditions and the lack of care for their patients that the Government are forcing them to adopt. I almost wonder whether the NHS is being deliberately run down in order to force people to turn to the private sector.
The final reason for our being here is because week after week, before and after the recess, at Prime Minister's Question Time, the Prime Minister—who, perhaps more than anybody else, is responsible for our Health Service


—has come to the Chamber and repeated statistic after statistic. That has not helped the people who are waiting for treatment.
To add insult to injury, when families from my area went to Downing street yesterday to plead with the Prime Minister to do something about their problems, she refused to see them. I can only hope that she did so because she was having urgent discussions with the Secretary of State so that a major decision could be announced today to assure the nation that the extra money that is so urgently needed, over and above existing resources, will be made available. I hope that we shall have that announcement.
Like every hon. Member who has spoken, I want to refer to my constituency. The last time that we debated the NHS, the Under-Secretary of State, the hon. Member for Derbyshire, South (Mrs. Currie), said:
Many hon. Members from the west midlands have spoken tonight. It is probably worth remembering that Birmingham is not the whole of the west midlands".
I agree with that. However, I did not agree with her when she went on to say that the House had not heard much from hon. Members representing other areas, including Stoke,
because they do not have much to whinge about." —[Official Report, 26 November 1987; Vol. 123, c. 472.]
Those of my hon. Friends who represent north Staffordshire have a great deal to whinge about. We have had meetings with the Under-Secretary of State, and she is fully aware of our problems. The hon. Lady is aware that a brand-new surgical block is due to be opened in Stoke-on-Trent at the end of the year, for which an extra £4 million is needed. If she cannot assure us that that money will be available, the Government will have a lot of explaining to do all over the country.
Secondly, we have a lot to whinge about because of RAWP, about which we have heard a lot this evening. Many hon. Members have complained that hospitals in their areas are closing because of RAWP, which means that money is being spent in other areas of Britain. I want to put on record the fact that the money that we in north Staffordshire should be getting as a result of the RAWP formula is not being spent in north Staffordshire —[Interruption.] It is not being spent in Birmingham because our special deprivation programme, which should have been £500,000 last year, and an additional £500,000 this year, was suspended last Wednesday simply because the money is no longer there. The reason for that is that the Government have refused point-blank to fund the nurses' pay award in full.
How can anybody plan the National Health Service with such uncertainty? The staff who are working in the Health Service are being given undertakings by the Government that certain money will be made available, but that pay increase is not being met in full and money is being taken away from other aspects of the NHS.
Another reason why we have much to whinge about in north Staffordshire is our orthopaedic waiting lists. I have been told—I have no doubt the figures are correct—that our waiting lists for orthopaedic hospitals are the longest in the west midlands, in the country and even in the universe — and this nation supposedly cares about health. A constituent of mine, a young man with a family, is now likely to have to wait for more than two years for an essential hip replacement operation. He will probably

lose his job while he is waiting. In north Staffordshire, we had a capital programme that was to give us about £10 million, to be spent on rebuilding orthopaedic units and replacing beds. Unfortunately, like the replacement psychiatric hospital service, that was another casualty of the cuts in the Health Service, and I am afraid that that capital programme has been suspended. We do not know when it will be reinstated.

Mr. William Cash: rose—

Ms. Walley: I have been waiting all night to speak and I do not intend to give way now.
The levels of deprivation concern me greatly. I entirely agree with the Secretary of State and the Under-Secretary of State when they say that nothing is more important than prevention. I know as well as anyone that waiting lists and deaths from lung and stomach cancer in north Staffordshire are possibly the highest in the country. I support any measure to prevent that amount of illness occurring in the first place. I want some recognition that we can solve the problems facing the National Health Service in both the short and long term.
All these issues, and many more, are crucial to people in north Staffordshire, but my final point is that the Government must accept the views of the people who work in the National Health Service. I refer to the nurses in Manchester who have already brought home how strongly they feel about proposals to introduce a flat-rate payment for overtime; to the blood transfusion workers who rightly said that enough was enough on hearing that the special duty payments that they were paid were likely to be taken away; and to all the workers who feel so strongly that the work they do is crucial to the National Health Service and who will not be satisfied until the Government, having examined the nurses' pay review, not only recommend that its proposals should be met in full, but make more money available. Such is my plea to the Government tonight.
The father of Claire Wise, my constituent who is waiting for an operation at the Birmingham children's hospital, told me when we were waiting in vain to see the Prime Minister yesterday that people who have good jobs and new homes may think that everything is all right, but if they do not have their health, their position is hopeless. I should like to think that the country was aware of his words and that some progress could be made here tonight. The Government climbed down before Christmas by giving us extra money, because they recognised that there was an overspend this year, and they climbed down over the flat-rate pay increases and the extra payments for blood transfusion workers. I hope that they will recognise their need to climb down from their failure to provide extra funding for the National Health Service. We have heard that the Treasury will have extra money. My constituents want that money to be spent on the National Health Service so that Claire Wise, like the Prime Minister, can have the treatment that she needs at the time she needs it—when she is well—before it is too late. It is a matter of life and death. The Government have the opportunity to act now. If they fail, it will be to everyone's cost.

Dr. David Mudd: The hon. Member for Stoke-on-Trent, North (Ms. Walley) was absolutely right when she said that these issues are crucial


to people. There has been too much of a tendency for politicians to consider their perceptions of the National Health Service, forgetting that the NHS involves members of the public and professional people working in the National Health Service. We should constantly be listening to those people, and doing our best to answer their demands.
Much has been said tonight about the RAWP formula. For the Cornwall and the Isles of Scilly health authority, that has led to a shortfall of about £30 million during the past 10 years. Now Nemesis is upon us. I shall speak briefly and bitterly of the effects in my constituency which has made the National Health Service virtually an endangered species.
Falmouth casualty unit, which treats more than 5,000 cases a year, is to be closed. Of course, the closure of that casualty unit will not stop 5,000 people needing attention for minor injuries and ailments. It will not make life more convenient for them in the height of summer when there are delays on the crowded roads between Falmouth and Truro, or in the winter when the roads are blocked by fallen trees. It will not help the manpower situation as the same number of staff will be required to deal with the same number of casualties. It will not help to increase the effective availability or use of ambulance services in critical cases.
Tehidy hospital is to be closed, causing, in the words of one consultant, "catastrophic consequences", in that the ensuing reallocation of beds will ultimately mean the loss of 23 surgical beds in the Royal Cornwall hospital in Truro. The highly successful stroke rehabilitation unit will be moved to what the consultant described as "unacceptable" accommodation in Truro and which even the local health authority admits to being "less than satisfactory". It means the loss of the highly successful mobility scheme which has assisted stroke-afflicted patients to become competent drivers.
Tragically, the Tehidy savings come when the Redruth Methodist community programme agency and the local league of friends of Tehidy hospital are pouring more practical support into the increased value of that distinguished and important hospital.
Paradoxically, Tehidy's finances could be improved by adding to its use rather than axing it. Thought should be given to it being partly used as a general practitioner hospital, catering for patients who do not need the high technology of the Royal Cornwall hospital at Truro. That would utilise the high commitment of local doctors, with the continuing dedication of the staff, and stimulate even more voluntary support from local agencies to create a lower cost per patient bed.
During the past six weeks, I have listened carefully to the views and suggestions of consultants, doctors, nurses and staff of the National Health Service in Cornwall, because, with the greatest respect, they know better than any of us that health cannot be quantified in profit and loss terms as easily as other economic issues. Some of the things that they have told me are food for thought—practical and compassionate thought, not political and insensitive thought. They told me that there is something wrong with the National Health Service when a highly trained anaesthetist is restricted in his professional choice of drugs. There is something wrong with the National Health Service when, in Cornwall, with an estimated 10 per cent. increase in confinements over the predictable future, maternity beds are being closed. There is something

wrong with the National Health Service when those urgently in need of check-ups, follow-ups or screening are denied the hospital car service to keep their appointments. There is something wrong with the National Health Service when facilities are closed before alternatives or replacements are available.
There is something wrong in the National Health Service when an incontinence adviser is added to the management structure to decide how many incontinence pads a patient should have. Above all, there is something wrong with a Government who cannot in any way change the public belief that the cuts are designed deliberately to ease the burden of those wealthy enough to pay tax. when in Cornwall many people either do not earn enough to pay tax or, sadly, are unemployed and so do not even have the dignity of work.

Ms. Harriet Harman: This year is the 40th anniversary of the Health Service. I understand that a staff member in the Department of Health and Social Security has been appointed to arrange celebrations, but in the 40th year of the Health Service there is great fear for its future and growing recognition that there is a crisis caused by lack of resources. People know from their own experience and the experience of their friends and relatives that there is a crisis in the Health Service. Nothing that the Prime Minister or Health Ministers say and no amount of figures they reel out can change that, because people know that it takes longer to get the treatment they need, and they wait in pain with their condition deteriorating. They know that when they finally get into hospital they are treated by nurses and doctors who are hard pressed and do not have enough time, and they are discharged from hospital very quickly—often before they are well enough to return home.
Not only patients recognise the crisis in the Health Service. The recognition has spread to doctors, among whom there has been an unprecedented outcry. Doctors have taken out advertisements in local newspapers in Oxford and west Berkshire. The British Medical Association has said that the National Health Service is in terminal decline and the presidents of the three royal colleges have talked about patient care deteriorating and services reaching breaking point. There have been petitions from doctors to Downing street and resolutions of regional and district health authorities.
Nurses have been warning the Government, particularly the 30,000 nurses who vote with their feet against the Health Service every year by leaving. Recruitment of nurses is dangerously low. For the first time, nurses have gone on strike in Manchester and Edinburgh. They are relatively demoralised because they cannot provide the care that they joined the Health Service to provide. To make matters worse, district health authorities are imposing recruitment freezes because they cannot pay the nurses they have.
Health Service organisations are unanimous about the developing crisis. The National Association of Health Authorities has said that the work of the Health Service is being jeopardised and community health councils have said that they are on the brink of collapse. National and local newspapers are overflowing with tragic cases of people dying before they get their operations and of mothers condemned to watch young children gasping for breath as they wait and wait for heart operations.
The Government are now slowly and reluctantly beginning to acknowledge that there is a crisis only in order to join the Right wing of the Conservative party in urging us to ditch the Health Service and start looking for alternatives. They say that we should look for an alternative system because the National Health Service is too expensive, but alternative systems are more expensive than ours. We spend £364 per head on health care, whereas in America £1,300 per head is spent on health care. The Institute of Actuaries has said that if our health system were run like that in America, we would overnight spend 10 per cent. more on health without getting any improvement in the service.
The Government try to make out that, whereas in the rest of Europe the percentage of GDP spent on health care is higher, the contribution from the public purse is lower in those countries than here. That is not the case. Our public sector contributes 5 per cent. of GDP on health, which is less than the public sector contribution in France, Belgium and Ireland. It is therefore a travesty to label the Health Service as greedy and out of control, when it is already substantially underfunded compared with health care systems abroad.
The Health Service treats patients more cost-effectively than the private sector. In the west midlands it costs the private sector £450 more to do a hysterectomy than a National Health Service hospital, and it costs the private sector £700 more to do a hip replacement operation than the National Health Service.
I expect that the right hon. Member for Chingford (Mr. Tebbit) would say that no account is taken of capital, but no account is taken in the private sector of the training of staff by the National Health Service, who then leave for the private sector.
We are told that we must have an alternative system because we cannot control Health Service costs, which are somehow spiralling out of control. It is true that costs are increasing, but that is partly because of the large number of elderly people. We should welcome that as an advance. I welcome the fact that my parents have been able to live to a ripe old age. I want to live to a ripe old age, and I want my children to do so. That should be welcomed as an advance in health and well-being, and should not be complained about by Conservative Members as being a problem. Costs have increased because of medical advance. We should be welcoming that rather than complaining and wishing to return to a system in which we cannot treat people and send them home without hope.
No lessons can be learnt from abroad about curtailing cost increases. The free-market or insurance-based system has a far greater rate of increase in costs. Last year, in the United States—in one year alone—costs rose by seven times more than the rate of inflation. Germany, which was given as an example by the right hon. Member for Chingford, has similar problems with runaway costs.
Alternative foreign systems are more expensive and less subject to cost control. If the Government are looking for alternatives to control costs, they are barking up the wrong tree.

Mr. Tebbit: rose—

Mr. Dennis Skinner: What are you doing, Mr. Speaker, letting the moonlighter in?

Mr. Tebbit: If the hon. Gentleman did a little moonlighting he might learn something. With a bit of luck, he might find someone willing to employ him.

Mr. Speaker: Order. Questions to the Front Bench, please.

Mr. Tebbit: Is it the hon. Lady's premise that we have nothing to learn from anyone overseas—that our system is perfect, we know it all, we know it better, we have got it all right and they have got it all wrong? Is she willing to learn something from other people's experience?

Ms. Harman: What I have learnt from other people's experience is that other systems are more expensive, more unfair, more bureaucratic and more costly.
The Government say that we need an alternative to the Health Service because it is bureaucratic. It has been described as a bureaucratic monster, but a certain amount of administration is necessary for a system to run properly. We want doctors and nurses to be free to care for patients, not to be bogged down with administration.
The Health Service demands less in administration than other systems abroad because it is simpler. We spend 6 per cent. of our health budget on administration. France, in which there is a large insurance element in its health service, spends 12 per cent. on administration—double the amount that we spend—and America spends 21 per cent. of its health budget on administration.

Mr. Whitney: Will the hon. Lady quote the source of that remark? She will know, if she has read anything about the matter, that academic studies show that the administrative costs of the United States health service account for 10 per cent. of its health budget. Our figure is so low because it does not include the cost of collection and because we have a centralised system. I invite the hon. Lady to tell the House where she obtained that figure of 21 per cent., which is one of the many bogus statistics that she is reading from her schoolgirl essay.

Ms. Harman: I am quoting internationally recognised OECD statistics. In some states of America the administrative costs amount to 30 per cent.
I should like to give the example of a friend of mine in America who took her son to hospital because he had to have a grommet placed in his ear. His operation was due at 9 am, but he was called in at 6 am so that staff could do three hours of administration and paper work. That is the way the system runs.
In Britain the private health care companies are far more expensive to administer than the NHS. Compared with the 6 per cent. that is spent by the NHS on administration, BUPA spends 10 per cent.. Therefore, the message is clear: insurance-based schemes are far more expensive to run than the NHS.
Another idea promoted by the Government is that the NHS is inefficient. It is true that underfunding is starting to reduce the efficiency of the Health Service and to cause unit costs to increase. Of course it is a waste of capital resources to have 50 per cent. of operating theatres—valuable capital resources — lying idle. Of course unit costs are increased if wards are closed and beds in wards are closed. Of course it increases staff costs to allow the nursing work force to decline to such a level that hospitals must increasingly rely upon expensive agency nurses. But that is not to say that we do not think that we should have


a continuous review of performance within the NHS. Of course we want value for money because we want value for patients.
All the evidence suggests that insurance-based or open-market systems of health care are far less efficient than the NHS in allocating resources. The absence of any coherent planning framework in the United States has led to an oversupply of hospital beds. It is estimated that between one in three and one in two of American hospital beds are surplus to requirements.
The medical director of BUPA in this country recently backed the idea that the Health Service is a good mechanism for planning and use of resources. He said:
Due to the structure of the NHS, the distribution of health services is reasonably good and there is relatively little waste—particularly when this is compared to America.
Perhaps the most important question is the access to care and the quality of care delivered by our Health Service compared with foreign systems. It is relatively well understood in Britain that the poor get a third-rate health care service in America. When an ambulance arrives at an accident in the United States, what the team is really interested in when deciding whether or where a victim should be treated is not where the nearest hospital is or where the appropriate facilities are available, but whether the person has got insurance.
There is no doubt that less well off people in the United States suffer because they delay seeking treatment and discharge themselves dangerously early because of the cost of health care. That is widely understood in Britain. It is also beginning to be understood that an insurance system is bound to allow gaps. It is estimated that more than 40 million people in the United States have no health insurance because insurance companies will not accept them because they are too old, because they have a chronic illness or because they are regarded as being an AIDS risk.
It is not as though someone is home and dry if he has an insurance policy, because there are also gruesome stories of insurance running out. When insurance runs out against a person's medical interest, he must move to a cheaper hospital. What is less well known, but extremely chilling, is that it is not only the poor who are the victims of the American health care system. The rich are also the victims of that system. It is a commercial system, and the doctors do what is profitable rather than what is medically necessary. For example, a doctor will not make much money from telling a patient with a headache to take an aspirin and lie down in a darkened room for an hour. Big money is made if the doctor starts brain and neurological investigations.
My hon. Friend the Member for Strathkelvin and Beardsden (Mr. Galbraith) has said that medicine in the United States is distorted by the profit motive. An American woman is three times more likely to have her womb removed than a British woman. An American man is four times more likely to have his prostate removed than a British man. An American is three times more likely than a Briton to have a hernia operation and twice as likely to have his tonsils removed. That is what happens in a health system in which the profit motive comes into play. An American woman is twice as likely as a British woman to give birth by caesarean section than by spontaneous delivery. A Congressional study estimated that 2.4 million surgical procedures had been carried out unnecessarily and that 11,900 deaths had been caused by unnecessary intervention.
That cannot be explained away by reference to different medical traditions or legal systems—although different medical traditions and different legal systems there are — because parallel differences exist in this country between the Health Service and the commercial medical sector. A woman in a private hospital is twice as likely to give birth by caesarian section as her counterpart in a National Health Service hospital. The alternatives that we are being offered by the Government are more expensive, more bureaucratic and more wasteful. They are unfair to the poor and they do no favours to the rich.
The central question is whether we want health care on the basis of people's ability to benefit from treatment or on the basis of their ability to pay for the treatment. The Health Service is fairer and more humane than commercial, insurance-based, profit-motivated systems. To any Government interested in acting sensibly, the obvious course of action would be to give the National Health Service a reasonable and fair allocation front public funds. We could then release all the enthusiasm and commitment that remain among doctors, nurses and other Health Service staff—enthusiasm and commitment that have not been stifled—who not only want to do more of what they are doing now but want to push back the boundaries of medical science, to make breakthroughs with new diagnostic techniques and treatments and so to improve our Health Service.
The Government and Conservative Back Benchers tell us that the money is available but that the Government are simply unwilling to use it for the Health Service. They prefer, as a matter of priority, to use it for tax cuts. The Government are considering abolishing the top rate of tax, which will benefit only 4 per cent. of people in this country but with a windfall of £850 million. They are considering abolishing inheritance tax, which will benefit only 35,0(10 people, but to the tune of £1 billion. The Government are considering plans to abolish capital gains tax to give a further windfall of £1.3 billion. Those amounts total more than £3 billion. While the Government pursue the theory that cuts in taxes encourage the rich to work harder, cuts in the Health Service are threatening people's lives.
In the year of the 40th anniversary of the Health Service, people will be paying particular attention to the Chancellor's treatment of the Health Service in his Budget. The real choice is not between the National Health Service and foreign systems, but between tax cuts and a soundly-based, well-resourced Health Service. Instead of forcing the Health Service to resort to flag-day finance, the Budget should use public finance to relieve the pain and suffering of the growing number of patients on the waiting lists. The Secretary of State tells the presidents of the royal colleges that the Health Service should get more money. The Chief Secretary to the Treasury says that it will not. People are expecting Budget day to be Health Service day. On 15 March, the eyes of all who care about a fair and effective health care system will be on the Chancellor.

The Minister for Health (Mr. Tony Newton): In many ways, this has been a more thoughtful and constructive debate than most of us expected at the outset—at least until the last few moments. The hon. Member for Peckham (Ms. Harman) appeared to be setting up nine-pins of her own making simply to knock them down. However, with that exception, hon. Members on both sides of the House have recognised—that recognition may be strategically


significant in terms of the whole political debate on the NHS—the complexity of the problems and pressures involved in the controversies and arguments that surround the National Health Service.
I want to comment on some of those themes and on the constructive points that have been made. However, before I come to what I take to be the central theme of the debate, it is right for me to comment on some of the specific points raised by right hon. and hon. Members from the Opposition Front Bench and by hon. Members of all parties, although inevitably I shall be unable to take up every point, especially some of the local ones.
I give an undertaking to the hon. Member for Livingston (Mr. Cook) that I shall not rehearse all the statistics that obviously leave him uneasy. One striking thing about his speech was what I took to be his extremely defensive comments when he sought to suggest that the statistics were not presenting a true picture of what is happening in the Health Service. Without seeking to repeat the statistics which my right hon. Friend the Secretary of State set out clearly in his opening speech, I challenge the hon. Gentleman to provide me with any significant measure of the outputs of the Health Service in terms of patient care which do not show the marked and dramatic increase that has taken place during the eight years that this Government have been in office.
However, I must challenge the hon. Member for Livingston on some statistics that I understood him to take from the report of the Select Committee on Social Services. I say in the presence of my hon. Friend the Member for Macclesfield (Mr. Winterton)— —[Interruption.] —unfortunately, he is not here — that I normally have the greatest respect for that Committee. However, I challenge the hon. Gentleman's statistics about the effect of demography on the pattern of Health Service expenditure in recent years because, in my judgment, there has been persistent misrepresentation of the position on the basis that the picture has remained steady and that a regular 1 per cent. per year has been needed to cope with demographic pressures. So much of the attack on our suggestions and our view that there has been a real increase in expenditure on the National Health Service rests on that statistic, and, frankly, it rests on a misapprehension. The run of statistics—

Mr. Robin Cook: rose—

Mr. Newton: May I first finish my point?
The run of statistics, which I can go through although I had not intended to, shows marked variations, down as low as 0·3 per cent., for example, for demographic factors in 1981–82. Over the period as a whole, the average is significantly less than 1 per cent. It is important that people should recognise that fact when making some of the wilder generalisations about the real increase in Health Service funding.

Mr. Cook: I invite the Minister to contemplate the answer that he gave to the House on 13 July 1987 when he set out the annual increase in the pressure of demographic change on the hospital sector alone. He is absolutely right —it is not 1 per cent. per annum; the figure varies. Over the period at which the Select Committee looked, there was a 4–3 per cent. additional requirement on the hospital sector. The Select Committee

estimated the increase in the volume terms of expenditure on the hospital sector as 3·2 per cent.—a clear 1·2 per cent. less. For next year it is a clear 2 per cent. less. That is why our hospitals cannot meet the demand on them. That is why they are in crisis and are turning away patients.

Mr. Newton: As I understand it, at least we agree that the 1 per cent. figure is an exaggeration as an average over the period concerned. Just as the hon. Gentleman and the hon. Member for Peckham have persistently refused to take account of the gains in efficiency in the service, so did the Select Committee. When account is taken of those factors, the increase in resources for the hospital and community health services represents a real increase which can be seen in the increases in patient care which all the statistics demonstrate.
I should like to make one other point to the hon. Member for Livingston, on a purely statistical issue. He referred to the representation of the British Cardiac Society about the number of cardiologists, quoting the society's reported view that some 10 million people were living in districts without the appropriate cardiological consultant care.
The number of consultant cardiologists has increased from 110 in 1979 to 152 on the latest available figure, an increase of more than 50 per cent. Although I have not been able to do all the maths involved, if 10 million people were living in districts without such consultants in 1986, that is a whole lot fewer than were living in such districts in 1979.

Mr. Nigel Griffiths: What consolation are those statistics to parents whose children are dying because of shortages?

Mr. Newton: Their consolation is that the increased resources for the hospitals and services involved create for their children a very much better chance of proper health care than they had eight years ago, when the Government came to office.
As the hon. Member for Edinburgh, South (Mr. Griffiths) has incited me, let me give one more statistic. —[Interruption.] Let him listen: he raised the subject. Let me give the hon. Gentleman the statistics for the number of hole-in-the-heart operations carried out on youngsters under one year old. In 1978, there were 333; in 1985—this is the latest figure that I have — there were 469. That is the scale of the increase.
I can give the House, and the hon. Member for Peckham, some helpful, up-to-date information. In the course of several references to nurses, the hon. Lady implied that the number had been falling. As it happens, I placed in the Library of the House yesterday the latest figures on NHS staff. I am glad to be able to tell the hon. Lady and the House that, in the year from September 1986 to September 1987, the number of nurses employed—excluding agency staff— rose by a further 3,400. That reflects the continuing increase that has taken place in the lifetime of the present Government.
There will always be legitimate public discussion and debate about the balance between expenditure and taxation at any one time, and about the balance in that expenditure between different desirable objectives —whether in health, education, housing or, for that matter, matters other than social policy such as defence, law and order or any other objective to which we attach collective


importance. What is not in doubt, however, is the commitment that the Government have shown by their decisions since 1979—

Mr. D. N. Campbell-Savours: What about nurse training?

Mr. Newton: The hon. Gentleman wishes me to go into the subject of nurse training, which was raised by the hon. Member for Cynon Valley (Mrs. Clwyd) in an intervention. The hon. Lady is right to say that there has been a modest decline in the total expenditure on nurse training over the past few years. There are two reasons for that. One is that there has been a reduction in the number of nurses leaving training before they complete that training which obviously tends to reduce the costs.

Mr. Campbell-Savours: Why?

Mr. Newton: There has been a reduction in the wastage. Why? Because no doubt they find it more attractive to be nurses now than they did when this Government came to office. Other factors are involved as well.
The Government have demonstrated by their decisions since 1979 the commitment they have to the Health Service, not only in the fact that expenditure has risen by 33 per cent. in real terms but that Health Service expenditure as a proportion of total public expenditure has risen by 2 per cent. in that period and, as my right hon. Friend said at the outset of the debate, the percentage of public expenditure on health in relation to the gross domestic product has risen from 4·7 per cent. to 5·4 per cent., after falling when the Labour party was in office.
The other point that has so far attracted less attention than I might have expected is that during the present year it is likely that health expenditure and personal social services expenditure, taken together, will overtake defence as the second largest item in Government expenditure after social security.

Mr. Anthony Beaumont-Dark: Before my right hon. Friend moves away from the main thrust. can he help many of us who are genuinely his friends— [Laughter.]—that is true—because many of us are perplexed? In Birmingham we are surrounded by great hospitals, good surgeons and good physicians who tell us — unless they are charlatans and liars, which I doubt but the Minister may convince me otherwise—that they are short of resources, that cancer beds are being closed and that kidney dialysis is rationed to those under 55 years of age. Either there are enough resources, or there are not. Who is right? Are those at the sharp end of public health right or is the Minister right?

Mr. Newton: The statistics that I have used —relatively few — and the figures that my right hon. Friend gave in his opening speech measure the increase in funds which has gone throughout the Health Service and not least to the West Midlands regional health authority, which has consistently gained under the process of resource allocation.

Mr. Campbell-Savours: Answer the question.

Mr. Newton: One point that I wish to deal with, because it is part of the core of the problem which both sides of the House face in talking about and dealing with these issues is that—

Mr. Campbell-Savours: Answer the question.

Mr. Speaker: Order. The Minister is trying to answer a question which has been put to him. It is no good the hon. Gentleman shouting across the Chamber at him.

Mr. Newton: I recognise that there is always more that people would like to do whether they are Health Service workers, Ministers or those to whom my hon. Friend has been speaking in Birmingham.
Whatever view is taken of spending, whether capital or current, present or past, one thing that should surely be clear to everyone who has participated in the debate is that there is no single, simple answer in anything that the lion. Member for Livingston suggested or, dare I say, in any of the many suggestions from hon. Members on both sides of the House.
It is right that we should examine the extent to which some of the proposals may be able to contribute, as indeed we are doing and will continue to do. The inescapable conclusion outlined by my right hon. Friend the Secretary of State is that the pattern of steadily rising demand, from factors that he described and above all from a combination of rising numbers of elderly people and the rapid pace or medical advance, is that we need to pursue steadily and consistently a range of measures of the sort that we have already embarked upon, not as a substitute for proper support from taxpayers nor a retreat from the responsibilities of Government, but in straightforward and practical recognition of the fact that, however much is contributed by taxpayers, there will always be more that all of us who are concerned with health would like to do.

Mr. Roland Boyes: A man came to my office recently to canvas my support to raise cash for Freeman hospital in Newcastle. He had written to a number of people, one of whom was the Prime Minister, to raise £50,000. He had a letter back from an aide to the Prime Minister, saying, in effect, "Find enclosed an autographed photograph of the Prime Minister, which has been used by many organisations to raise a considerable amount of money." How many autographed photographs does it take to run a Health Service?

Mr. Newton: Mention of Newcastle reminds me of my visit there, when I saw at the Freeman hospital undoubtedly the finest heart transplant unit in this country. It was designated and paid for by funds allocated by this Government since 1979.
The sad thing about the debate today is that the Opposition have not only sought to deny their past, but have resolutely ignored the real issues and practical problems that must be faced. A smile came to my face—

Mr. Campbell-Savours: rose—

Mr. Newton: No, I shall not give way to the hon. Gentleman. A smile came to my face when I heard the hon. Member for Livingston challenge us on the basis that no problems had occurred in the Health Service under the previous Labour Administration. I have in my hand copies of some headlines from newspapers in 1978 —[Interruption.] In March 1978, the headlines were:
Patients sent home early to release beds, doctors say; NHS morale falling, MPs told; Minister told of threat to nursing standards; Big injection of money essential to resuscitate National Health Service, doctors told; Heart patients will die, warning in hospital dispute".
Then, most telling of all, there is a headline from The Times of August 1978 in the "Home News", which says:


NHS in crisis; doctors complain of chronic under-financing.
That was what happened under the previous Labour Government. If we do not go down the track that they urge of taking yet more money from taxpayers, it is because we are conscious that down that track lies the same failure to fund the Health Service properly that marked the whole of their period in government. What we can and will do is to build on the expansion that we have already brought about.

Question put, That the original words stand part of the Question:—

The House divided: Ayes 233, Noes 338.

Division NO. 144]
[10 pm


AYES


Abbott, Ms Diane
Dewar, Donald


Adams, Allen (Paisley N)
Dixon, Don


Allen, Graham
Dobson, Frank


Alton, David
Douglas, Dick


Archer, Rt Hon Peter
Dunnachie, James


Armstrong, Ms Hilary
Dunwoody, Hon Mrs Gwyneth


Ashdown, Paddy
Eadie, Alexander


Ashley, Rt Hon Jack
Eastham, Ken


Ashton, Joe
Ewing, Harry (Falkirk E)


Banks, Tony (Newham NW)
Ewing, Mrs Margaret (Moray)


Barnes, Harry (Derbyshire NE)
Fatchett, Derek


Barnes, Mrs Rosie (Greenwich)
Faulds, Andrew


Barron, Kevin
Fearn, Ronald


Battle, John
Field, Frank (Birkenhead)


Beckett, Margaret
Fields, Terry (L'pool B G'n)


Beith, A. J.
Fisher, Mark


Bell, Stuart
Flannery, Martin


Benn, Rt Hon Tony
Flynn, Paul


Bennett, A. F. (D'nt'n &amp; R'dish)
Foot, Rt Hon Michael


Bermingham, Gerald
Forsythe, Clifford (Antrim S)


Bidwell, Sydney
Foster, Derek


Blair, Tony
Foulkes, George


Blunkett, David
Fraser, John


Boyes, Roland
Fyfe, Mrs Maria


Bradley, Keith
Galbraith, Samuel


Bray, Dr Jeremy
Galloway, George


Brown, Gordon (D'mline E)
Garrett, John (Norwich South)


Brown, Nicholas (Newcastle E)
Garrett, Ted (Wallsend)


Brown, Ron (Edinburgh Leith)
George, Bruce


Bruce, Malcolm (Gordon)
Gilbert, Rt Hon Dr John


Buchan, Norman
Godman, Dr Norman A.


Buckley, George
Golding, Mrs Llin


Caborn, Richard
Gordon, Ms Mildred


Callaghan, Jim
Grant, Bernie (Tottenham)


Campbell, Ron (Blyth Valley)
Griffiths, Nigel (Edinburgh S)


Campbell-Savours, D. N.
Griffiths, Win (Bridgend)


Canavan, Dennis
Grocott, Bruce


Carlile, Alex (Mont'g)
Hardy, Peter


Clark, Dr David (S Shields)
Harman, Ms Harriet


Clarke, Tom (Monklands W)
Hattersley, Rt Hon Roy


Clay, Bob
Haynes, Frank


Clelland, David
Healey, Rt Hon Denis


Clwyd, Mrs Ann
Heffer, Eric S.


Cohen, Harry
Hinchliffe, David


Coleman, Donald
Hogg, N. (C'nauld &amp; Kilsyth)


Cook, Robin (Livingston)
Holland, Stuart


Corbett, Robin
Home Robertson, John


Corbyn, Jeremy
Hood, James


Cousins, Jim
Howarth, George (Knowsley N)


Cox, Tom
Howell, Rt Hon D. (S'heath)


Crowther, Stan
Howells, Geraint


Cryer, Bob
Hoyle, Doug


Cummings, J.
Hughes, John (Coventry NE)


Cunliffe, Lawrence
Hughes, Robert (Aberdeen N)


Dalyell, Tarn
Hughes, Roy (Newport E)


Darling, Alastair
Hughes, Simon (Southwark)


Davies, Rt Hon Denzil (Lianelli)
Illsley, Eric


Davies, Ron (Caerphilly)
Ingram, Adam


Davis, Terry (B'ham Hodge H'l)
Janner, Greville





John, Brynmor
Radice, Giles


Jones, Barry (Alyn &amp; Deeside)
Randall, Stuart


Jones, leuan (Ynys M6n)
Redmond, Martin


Jones, Martyn (Clwyd S W)
Rees, Rt Hon Merlyn


Kaufman, Rt Hon Gerald
Reid, John


Kilfedder, James
Richardson, Ms Jo


Kinnock, Rt Hon Neil
Roberts, Allan (Bootle)


Kirkwood, Archy
Robertson, George


Lamble, David
Robinson, Geoffrey


Lamond, James
Rooker, Jeff


Leadbitter, Ted
Ross, Ernie (Dundee W)


Leighton, Ron
Ross, William (Londonderry E)


Lestor, Miss Joan (Eccles)
Rowlands, Ted


Lewis, Terry
Ruddock, Ms Joan


Litherland, Robert
Salmond, Alex


Livingstone, Ken
Sedgemore, Brian


Livsey, Richard
Sheerman, Barry


Lloyd, Tony (Stretford)
Sheldon, Rt Hon Robert


Lofthouse, Geoffrey
Shore, Rt Hon Peter


Loyden, Eddie
Short, Clare


McAllion, John
Skinner, Dennis


McAvoy, Tom
Smith, Andrew (Oxford E)


McCartney, Ian
Smith, C. (Isl'ton &amp; Fbury)


McCusker, Harold
Smith, Rt Hon J. (Monk'ds E)


Macdonald, Calum
Smyth, Rev Martin (Belfast S)


McKelvey, William
Snape, Peter


McLeish, Henry
Soley, Clive


Maclennan, Robert
Spearing, Nigel


McNamara, Kevin
Steel, Rt Hon David


McTaggart, Bob
Steinberg, Gerald


McWilliam, John
Stott, Roger


Madden, Max
Strang, Gavin


Mahon, Mrs Alice
Straw, Jack


Marshall, David (Shettleston)
Taylor, Mrs Ann (Dewsbury)


Marshall, Jim (Leicester S)
Taylor, Matthew (Truro)


Martin, Michael (Springburn)
Thomas, Dafydd Elis


Martlew, Eric
Thompson, Jack (Wansbeck)


Maxton, John
Turner, Dennis


Meacher, Michael
Vaz, Keith


Meale, Alan
Walker, A. Cecil (Belfast N)


Michael, Alun
Wall, Pat


Michie, Bill (Sheffield Heeley)
Wallace, James


Millan, Rt Hon Bruce
Walley, Ms Joan


Mitchell, Austin (G't Grimsby)
Wardell, Gareth (Gower)


Molyneaux, Rt Hon James
Wareing, Robert N.


Moonie, Dr Lewis
Welsh, Andrew (Angus E)


Morris, Rt Hon A (W'shawe)
Welsh, Michael (Doncaster N)


Morris, Rt Hon J (Aberavon)
Wigley, Dafydd


Mowlam, Marjorie
Williams, Rt Hon A. J.


Mullin, Chris
Williams, Alan W. (Carm'then)


Nellist, Dave
Wilson, Brian


Oakes, Rt Hon Gordon
Winnick, David


O'Brien, William
Wise, Mrs Audrey


Orme, Rt Hon Stanley
Worthington, Anthony


Patchett, Terry
Young, David (Bolton SE)


Pendry, Tom



Pike, Peter
Tellers for the Ayes:


Powell, Ray (Ogmore)
Mr. Frank Cook and


Primarolo, Ms Dawn
Mr. Allen McKay.


Quin, Ms Joyce



NOES


Adley, Robert
Beaumont-Dark, Anthony


Aitken, Jonathan
Bellingharn, Henry


Alexander, Richard
Bendall, Vivian


Alison, Rt Hon Michael
Bennett, Nicholas (Pembroke)


Allason, Rupert
Benyon, W.


Amery, Rt Hon Julian
Bevan, David Gilroy


Amess, David
Biffen, Rt Hon John


Amos, Alan
Biggs-Davison, Sir John


Arbuthnot, James
Blackburn, Dr John G.


Arnold, Tom (Hazel Grove)
Blaker, Rt Hon Sir Peter


Ashby, David
Body, Sir Richard


Aspinwall, Jack
Bonsor, Sir Nicholas


Atkins, Robert
Boswell, Tim


Atkinson, David
Bottomley, Peter


Baker, Rt Hon K. (Mole Valley)
Bottomley, Mrs Virginia


Baker, Nicholas (Dorset N)
Bowden, A (Brighton K'pto'n)


Baldry, Tony
Bowden, Gerald (Dulwich)


Batiste, Spencer
Bowis, John






Boyson, Rt Hon Dr Sir Rhodes
Gow, Ian


Braine, Rt Hon Sir Bernard
Gower, Sir Raymond


Brandon-Bravo, Martin
Greenway, Harry (Eating N)


Brazier, Julian
Greenway, John (Rydale)


Bright, Graham
Gregory, Conal


Brittan, Rt Hon Leon
Griffiths, Sir Eldon (Bury St E')


Brooke, Rt Hon Peter
Griffiths, Peter (Portsmouth N)


Brown, Michael (Brigg &amp; Cl't's)
Grist, Ian


Browne, John (Winchester)
Ground, Patrick


Bruce, Ian (Dorset South)
Grylls, Michael


Buchanan-Smith, Rt Hon Alick
Hamilton, Neil (Tatton)


Buck, Sir Antony
Hampson, Dr Keith


Budgen, Nicholas
Hanley, Jeremy


Burns, Simon
Hannam, John


Burt, Alistair
Hargreaves, A. (B'ham H'll Gr')


Butcher, John
Hargreaves, Ken (Hyndburn)


Butler, Chris
Harris, David


Butterfill, John
Haselhurst, Alan


Carlisle, John, (Luton N)
Hawkins, Christopher


Carlisle, Kenneth (Lincoln)
Hayes, Jerry


Carrington, Matthew
Hayward, Robert


Carttiss, Michael
Heathcoat-Amory, David


Cash, William
Heddle, John


Channon, Rt Hon Paul
Heseltine, Rt Hon Michael


Chapman, Sydney
Hicks, Mrs Maureen (Wolv' NE)


Chope, Christopher
Hicks, Robert (Cornwall SE)


Churchill, Mr
Higgins, Rt Hon Terence L.


 Clark, Hon Alan (Plym'th S'n)
Hill, James


Clark, Dr Michael (Rochford)
Hind, Kenneth


Clark, Sir W. (Croydon S)
Hogg, Hon Douglas (Gr'th'm)


Clarke, Rt Hon K. (Rushcliffe)
Holt, Richard


Colvin, Michael
Hordern, Sir Peter


Conway, Derek
Howard, Michael


Coombs, Anthony (Wyre F'rest)
Howarth, Alan (Strat'd-on-A)


Coombs, Simon (Swindon)
Howarth, G. (Cannock &amp; B'wd)


Cope, John
Howe, Rt Hon Sir Geoffrey


Cormack, Patrick
Howell, Ralph (North Norfolk)


Couchman, James
Hughes, Robert G. (Harrow W)


Cran, James
Hunt, David (Wirral W)


Currie, Mrs Edwina
Hunt, John (Ravensbourne)


Curry, David
Hunter, Andrew


Davies, Q. (Stamf'd &amp; Spald'g)
Irvine, Michael


Davis, David (Boothferry)
Irving, Charles


Day, Stephen
Jack, Michael


Devlin, Tim
Jackson, Robert


Dickens, Geoffrey
Janman, Timothy


Dicks, Terry
Johnson Smith, Sir Geoffrey


Dorrell, Stephen
Jones, Gwilym (Cardiff N)


Douglas-Hamilton, Lord James
Jones, Robert B (Herts W)


Dover, Den
Kellett-Bowman, Mrs Elaine


Dunn, Bob
Key, Robert


Durant, Tony
King, Roger (B'ham N'thfleld)


Emery, Sir Peter
Kirkhope, Timothy


Evennett, David
Knapman, Roger


Fallon, Michael
Knight, Greg (Derby North)


Farr, Sir John
Knight, Dame Jill (Edgbaston)


Favell, Tony
Knowles, Michael


Fenner, Dame Peggy
Knox, David


Field, Barry (Isle of Wight)
Lamont, Rt Hon Norman


Finsberg, Sir Geoffrey
Lang, Ian


Fookes, Miss Janet
Latham, Michael


Forman, Nigel
Lawrence, Ivan


Forsyth, Michael (Stirling)
Lawson, Rt Hon Nigel


Forth, Eric
Lee, John (Pendle)


Fowler, Rt Hon Norman
Leigh, Edward (Gainsbor'gh)


Fox, Sir Marcus
Lennox-Boyd, Hon Mark


Franks, Cecil
Lester, Jim (Broxtowe)


Freeman, Roger
Lightbown, David


French, Douglas
Lilley, Peter


Fry, Peter
Lloyd, Sir Ian (Havant)


Gale, Roger
Lloyd, Peter (Fareham)


Gardiner, George
Lord, Michael


Gill, Christopher
Luce, Rt Hon Richard


Gilmour, Rt Hon Sir Ian
Lyell, Sir Nicholas


Glyn, Dr Alan
McCrindle, Robert


Goodhart, Sir Philip
Macfarlane, Sir Neil


Goodlad, Alastair
MacKay, Andrew (E Berkshire)


Goodson-Wickes, Dr Charles
Maclean, David


Gorman, Mrs Teresa
McLoughlin, Patrick


Gorst, John
McNair-Wilson, M. (Newbury)





McNair-Wilson, P. (New Forest)
Shepherd, Richard (Aldridge)


Madel, David
Shersby, Michael


Major, Rt Hon John
Sims, Roger


Malins, Humfrey
Skeet, Sir Trevor


Mans, Keith
Smith, Sir Dudley (Warwick)


Maples, John
Smith, Tim (Beaconsfield)


Marland, Paul
Soames, Hon Nicholas


Marlow, Tony
Speed, Keith


Martin, David (Portsmouth S)
Speller, Tony


Mates, Michael
Spicer, Sir Jim (Dorset W)


Mawhinney, Dr Brian
Spicer, Michael (S Worcs)


Mayhew, Rt Hon Sir Patrick
Squire, Robin


Mellor, David
Stanbrook, Ivor


Miller, Hal
Steen, Anthony


Mills, Iain
Stern, Michael


Miscampbell, Norman
Stevens, Lewis


Mitchell, Andrew (Gedling)
Stewart, Allan (Eastwood)


Mitchell, David (Hants NW)
Stewart, Andrew (Sherwood)


Moate, Roger
Stokes, John


Monro, Sir Hector
Stradling Thomas, Sir John


Montgomery, Sir Fergus
Sumberg, David


Moore, Rt Hon John
Summerson, Hugo


Morris, M (N'hampton S)
Tapsell, Sir Peter


Morrison, Sir Charles (Devizes)
Taylor, Ian (Esher)


Moss, Malcolm
Taylor, John M (Solihull)


Mudd, David
Taylor, Teddy (S'end E)


Neale, Gerrard
Tebbit, Rt Hon Norman


Nelson, Anthony
Temple-Morris, Peter


Neubert, Michael
Thompson, D. (Calder Valley)


Newton, Rt Hon Tony
Thompson, Patrick (Norwich N)


Nicholls, Patrick
Thorne, Neil


Nicholson, David (Taunton)
Thornton, Malcolm


Nicholson, Miss E. (Devon W)
Thurnham, Peter


Onslow, Rt Hon Cranley
Townend, John (Bridlington)


Page, Richard
Townsend, Cyril D. (B'heath)


Paice, James
Tracey, Richard


Parkinson, Rt Hon Cecil
Tredinnick, David


Patnick, Irvine
Trippier, David


Patten, Chris (Bath)
Trotter, Neville


Patten, John (Oxford W)
Twinn, Dr Ian


Pattie, Rt Hon Sir Geoffrey
Vaughan, Sir Gerard


Pawsey, James
Waddington, Rt Hon David


Peacock, Mrs Elizabeth
Wakeham, Rt Hon John


Porter, Barry (Wirral S)
Waldegrave, Hon William


Porter, David (Waveney)
Walden, George


Portillo, Michael
Walker, Bill (T'side North)


Price, Sir David
Walker, Rt Hon P. (W'cester)


Raff an, Keith
Waller, Gary


Raison, Rt Hon Timothy
Walters, Dennis


Rathbone, Tim
Ward, John


Redwood, John
Wardle, C. (Bexhill)


Renton, Tim
Warren, Kenneth


Rhodes James, Robert
Watts, John


Rhys Williams, Sir Brandon
Wells, Bowen


Riddick, Graham
Wheeler, John


Ridley, Rt Hon Nicholas
Whitney, Ray


Rifkind, Rt Hon Malcolm
Widdecombe, Miss Ann


Roberts, Wyn (Conwy)
Wiggin, Jerry


Roe, Mrs Marion
Wilkinson, John


Rossi, Sir Hugh
Wilshire, David


Rost, Peter
Winterton, Mrs Ann


Rowe, Andrew
Winterton, Nicholas


Rumbold, Mrs Angela
Wolfson, Mark


Ryder, Richard
Wood, Timothy


Sackville, Hon Tom
Woodcock, Mike


Sayeed, Jonathan
Yeo, Tim


Scott, Nicholas
Young, Sir George (Acton)


Shaw, David (Dover)
Younger, Rt Hon George


Shaw, Sir Giles (Pudsey)



Shaw, Sir Michael (Scarb')
Tellers for the Noes:


Shelton, William (Streatham)
Mr. Robert Boscawen and


Shephard, Mrs G. (Norfolk SW)
Mr. Tristan Garel-Jones.


Shepherd, Colin (Hereford)

Question accordingly negatived.

Questin, That the proposed words be there added, put forthwith pursuant to Standing Order No. 30 (Questions on amendments):—

The House divided: Ayes 336, Noes 236.

Division No. 145]
[10.15 pm


AYES


Adley, Robert
Davis, David (Boothferry)


Aitken, Jonathan
Day, Stephen


Alexander, Richard
Devlin, Tim


Alison, Rt Hon Michael
Dickens, Geoffrey


Allason, Rupert
Dicks, Terry


Amery, Rt Hon Julian
Dorrell, Stephen


Amess, David
Douglas-Hamilton, Lord James


Amos, Alan
Dover, Den


Arbuthnot, James
Dunn, Bob


Arnold, Tom (Hazel Grove)
Durant, Tony


Ashby, David
Emery, Sir Peter


Aspinwall, Jack
Evennett, David


Atkins, Robert
Fallon, Michael


Atkinson, David
Farr, Sir John


Baker, Rt Hon K. (Mole Valley)
Favell, Tony


Baker, Nicholas (Dorset N)
Fenner, Dame Peggy


Baldry, Tony
Field, Barry (Isle of Wight)


Batiste, Spencer
Finsberg, Sir Geoffrey


Beaumont-Dark, Anthony
Fookes, Miss Janet


Bellingham, Henry
Forman, Nigel


Bendall, Vivian
Forsyth, Michael (Stirling)


Bennett, Nicholas (Pembroke)
Forth, Eric


Benyon, W.
Fowler, Rt Hon Norman


Bevan, David Gilroy
Fox, Sir Marcus


Biffen, Rt Hon John
Franks, Cecil


Biggs-Davison, Sir John
Freeman, Roger


Blackburn, Dr John G.
French, Douglas


Blaker, Rt Hon Sir Peter
Fry, Peter


Body, Sir Richard
Gale, Roger


Bonsor, Sir Nicholas
Gardiner, George


Boswell, Tim
Gill, Christopher


Bottomley, Peter
Gilmour, Rt Hon Sir Ian


Bottomley, Mrs Virginia
Glyn, Dr Alan


Bowden, A (Brighton K'pto'n)
Goodhart, Sir Philip


Bowden, Gerald (Dulwich)
Goodlad, Alastair


Bowis, John
Goodson-Wickes, Dr Charles


Boyson, Rt Hon Dr Sir Rhodes
Gorman, Mrs Teresa


Braine, Rt Hon Sir Bernard
Gorst, John


Brandon-Bravo, Martin
Gow, Ian


Brazier, Julian
Gower, Sir Raymond


Bright, Graham
Grant, Sir Anthony (CambsSW)


Brittan, Rt Hon Leon
Greenway, Harry (Ealing N)


Brooke, Rt Hon Peter
Greenway, John (Rydale)


Brown, Michael (Brigg &amp; Cl't's)
Gregory, Conal


Browne, John (Winchester)
Griffiths, Sir Eldon (Bury St E')


Bruce, Ian (Dorset South)
Griffiths, Peter (Portsmouth N)


Buchanan-Smith, Rt Hon Alick
Grist, Ian


Buck, Sir Antony
Ground, Patrick


Budgen, Nicholas
Grylls, Michael


Burns, Simon
Hamilton, Neil (Tatton)


Burt, Alistair
Hampson, Dr Keith


Butcher, John
Hanley, Jeremy


Butler, Chris
Hannam, John


Butterfill, John
Hargreaves, A. (B'ham H'll Gr')


Carlisle, John, (Luton N)
Hargreaves, Ken (Hyndburn)


Carlisle, Kenneth (Lincoln)
Harris, David


Carrington, Matthew
Haselhurst, Alan


Carttiss, Michael
Hawkins, Christopher


Cash, William
Hayes, Jerry


Channon, Rt Hon Paul
Hayhoe, Rt Hon Sir Barney


Chapman, Sydney
Hayward, Robert


Chope, Christopher
Heathcoat-Amory, David


Churchill, Mr
Heddle, John


Clark, Hon Alan (Plym'th S'n)
Heseltine, Rt Hon Michael


Clark, Dr Michael (Rochford)
Hicks, Mrs Maureen (Wolv' NE)


Clark, Sir W. (Croydon S)
Hicks, Robert (Cornwall SE)


Clarke, Rt Hon K. (Rushcliffe)
Higgins, Rt Hon Terence L.


Colvin, Michael
Hill, James


Conway, Derek
Hind, Kenneth


Coombs, Anthony (Wyre F'rest)
Hogg, Hon Douglas (Gr'th'm)


Coombs, Simon (Swindon)
Holt, Richard


Cope, John
Hordern, Sir Peter


Cormack, Patrick
Howard, Michael


Couchman, James
Howarth, Alan (Strat'd-on-A)


Cran, James
Howarth, G. (Cannock &amp; B'wd)


Currie, Mrs Edwina
Howell, Ralph (North Norfolk)


Curry, David
Hughes, Robert G. (Harrow W)


Davies, Q. (Stamf'd &amp; Spald'g)
Hunt, David (Wirral W)





Hunt, John (Ravensbourne)
Pawsey, James


Hunter, Andrew
Peacock, Mrs Elizabeth


Irvine, Michael
Porter, Barry (Wirral S)


Irving, Charles
Porter, David (Waveney)


Jack, Michael
Portillo, Michael


Jackson, Robert
Price, Sir David


Janman, Timothy
Raffan, Keith


Johnson Smith, Sir Geoffrey
Raison, Rt Hon Timothy


Jones, Gwilym (Cardiff N)
Rathbone, Tim


Jones, Robert B (Herts W)
Redwood, John


Kellett-Bowman, Mrs Elaine
Renton, Tim


Key, Robert
Rhodes James, Robert


King, Roger (B'ham N'thfield)
Rhys Williams, Sir Brandon


Kirkhope, Timothy
Riddick, Graham


Knapman, Roger
Rifkind, Rt Hon Malcolm


Knight, Greg (Derby North)
Roberts, Wyn (Conwy)


Knowles, Michael
Roe, Mrs Marion


Knox, David
Rossi, Sir Hugh


Lamont, Rt Hon Norman
Rost, Peter


Lang, Ian
Rowe, Andrew


Latham, Michael
Rumbold, Mrs Angela


Lawrence, Ivan
Ryder, Richard


Lawson, Rt Hon Nigel
Sackville, Hon Tom


Lee, John (Pendle)
Sainsbury, Hon Tim


Leigh, Edward (Gainsbor'gh)
Sayeed, Jonathan


Lennox-Boyd, Hon Mark
Scott, Nicholas


Lester, Jim (Broxtowe)
Shaw, David (Dover)


Lightbown, David
Shaw, Sir Giles (Pudsey)


Lilley, Peter
Shaw, Sir Michael (Scarb')


Lloyd, Sir Ian (Havant)
Shelton, William (Streatham)


Lloyd, Peter (Fareham)
Shephard, Mrs G. (Norfolk SW)


Lord, Michael
Shepherd, Colin (Hereford)


Luce, Rt Hon Richard
Shepherd, Richard (Aldridge)


Lyell, Sir Nicholas
Shersby, Michael


McCrindle, Robert
Sims, Roger


Macfarlane, Sir Neil
Skeet, Sir Trevor


MacKay, Andrew (E Berkshire)
Smith, Sir Dudley (Warwick)


Maclean, David
Smith, Tim (Beaconsfield)


McLoughlin, Patrick
Soames, Hon Nicholas


McNair-Wilson, M. (Newbury)
Speed, Keith


McNair-Wilson, P. (New Forest)
Speller, Tony


Madel, David
Spicer, Sir Jim (Dorset W)


Major, Rt Hon John
Spicer, Michael (S Worcs)


Malins, Humfrey
Squire, Robin


Mans, Keith
Stanbrook, Ivor


Maples, John
Steen, Anthony


Marland, Paul
Stern, Michael


Marlow, Tony
Stevens, Lewis


Martin, David (Portsmouth S)
Stewart, Allan (Eastwood)


Mates, Michael
Stewart, Andrew (Sherwood)


Mawhinney, Dr Brian
Stokes, John


Mayhew, Rt Hon Sir Patrick
Stradling Thomas, Sir John


Mellor, David
Sumberg, David


Miller, Hal
Summerson, Hugo


Mills, lain
Tapsell, Sir Peter


Miscampbell, Norman
Taylor, Ian (Esher)


Mitchell, Andrew (Gedling)
Taylor, John M (Solihull)


Mitchell, David (Hants NW)
Taylor, Teddy (S'end E)


Moate, Roger
Tebbit, Rt Hon Norman


Monro, Sir Hector
Temple-Morris, Peter


Montgomery, Sir Fergus
Thompson, D. (Calder Valley)


Moore, Rt Hon John
Thompson, Patrick (Norwich N)


Morris, M (N'hampton S)
Thorne, Neil


Morrison, Sir Charles (Devizes)
Thornton, Malcolm


Moss, Malcolm
Thurnham, Peter


Mudd, David
Townend, John (Bridlington)


Neale, Gerrard
Townsend, Cyril D. (B'heath)


Nelson, Anthony
Tracey, Richard


Neubert, Michael
Tredinnick, David


Newton, Rt Hon Tony
Trippier, David


Nicholls, Patrick
Trotter, Neville


Nicholson, David (Taunton)
Twinn, Dr Ian


Nicholson, Miss E. (Devon W)
Vaughan, Sir Gerard


Onslow, Rt Hon Cranley
Waddington, Rt Hon David


Page, Richard
Wakeham, Rt Hon John


Paice, James
Waldegrave, Hon William


Parkinson, Rt Hon Cecil
Walden, George


Patten, Chris (Bath)
Walker, Bill (T'side North)


Patten, John (Oxford W)
Walker, Rt Hon P. (W'cester)


Pattie, Rt Hon Sir Geoffrey
Waller, Gary






Walters, Dennis
Winterton, Mrs Ann


Ward, John
Winterton, Nicholas


Wardle, C. (Bexhill)
Wolfson, Mark


Warren, Kenneth
Wood, Timothy


Watts, John
Woodcock, Mike


Wells, Bowen
Yeo, Tim


Wheeler, John
Young, Sir George (Acton)


Whitney, Ray
Younger, Rt Hon George


Widdecombe, Miss Ann



Wiggin, Jerry
Tellers for the Ayes:


Wilkinson, John
Mr. Robert Boscawen and


Wilshire, David
Mr. Tristan Garel-Jones.


NOES


Abbott, Ms Diane
Dobson, Frank


Adams, Allen (Paisley N)
Doran, Frank


Allen, Graham
Douglas, Dick


Alton, David
Dunnachie, James


Archer, Rt Hon Peter
Dunwoody, Hon Mrs Gwyneth


Armstrong, Ms Hilary
Eadie, Alexander


Ashdown, Paddy
Eastham, Ken


Ashley, Rt Hon Jack
Evans, John (St Helens N)


Ashton, Joe
Ewing, Harry (Falkirk E)


Banks, Tony (Newham NW)
Ewing, Mrs Margaret (Moray)


Barnes, Harry (Derbyshire NE)
Fatchett, Derek


Barnes, Mrs Rosie (Greenwich)
Faulds, Andrew


Barron, Kevin
Fearn, Ronald


Battle, John
Field, Frank (Birkenhead)


Beckett, Margaret
Fields, Terry (L'pool B G'n)


Beith, A. J.
Fisher, Mark


Bell, Stuart
Flannery, Martin


Benn, Rt Hon Tony
Flynn, Paul


Bennett, A. F. (D'nt'n &amp;, R'dish)
Foot, Rt Hon Michael


Bermingham, Gerald
Forsythe, Clifford (Antrim S)


Bidwell, Sydney
Foster, Derek


Blair, Tony
Foulkes, George


Blunkett, David
Fraser, John


Boyes, Roland
Fyfe, Mrs Maria


Bradley, Keith
Galbraith, Samuel


Bray, Dr Jeremy
Galloway, George


Brown, Gordon (D'mline E)
Garrett, John (Norwich South)


Brown, Nicholas (Newcastle E)
Garrett, Ted (Walisend)


Brown, Ron (Edinburgh Leith)
George, Bruce


Bruce, Malcolm (Gordon)
Gilbert, Rt Hon Dr John


Buchan, Norman
Godman, Dr Norman A.


Buckley, George
Golding, Mrs Llin


Caborn, Richard
Gordon, Ms Mildred


Callaghan, Jim
Grant, Bernie (Tottenham)


Campbell, Ron (Blyth Valley)
Griffiths, Nigel (Edinburgh S)


Campbell-Savours, D. N.
Griffiths, Win (Bridgend)


Canavan, Dennis
Grocott, Bruce


Carlile, Alex (Mont'g)
Hardy, Peter


Clark, Dr David (S Shields)
Harman, Ms Harriet


Clarke, Tom (Monklands W)
Hattersley, Rt Hon Roy


Clay, Bob
Haynes, Frank


Clelland, David
Healey, Rt Hon Denis


Clwyd, Mrs Ann
Heffer, Eric S.


Cohen, Harry
Hinchliffe, David


Coleman, Donald
Hogg, N. (C'nauld &amp; Kilsyth)


Cook, Robin (Livingston)
Holland, Stuart


Corbett, Robin
Home Robertson, John


Corbyn, Jeremy
Hood, James


Cousins, Jim
Howarth, George (Knowsley N)


Cox, Tom
Howell, Rt Hon D. (S'heath)


Crowther, Stan
Howells, Geraint


Cryer, Bob
Hoyle, Doug


Cummings, J.
Hughes, John (Coventry NE)


Cunliffe, Lawrence
Hughes, Robert (Aberdeen N)


Dalyell, Tam
Hughes, Roy (Newport E)


Darling, Alastair
Hughes, Simon (Southwark)


Davies, Rt Hon Denzil (Lianelli)
Illsley, Eric


Davies, Ron (Caerphilly)
Ingram, Adam


Davis, Terry (B'ham Hodge H'l)
Janner, Greville


Dewar, Donald
John, Brynmor


Dixon, Don
Jones, Barry (Alyn &amp; Deeside)





Jones, leuan (Ynys Môn)
Radice, Giles


Jones, Martyn (Clwyd S W)
Randall, Stuart


Kaufman, Rt Hon Gerald
Redmond, Martin


Kilfedder, James
Rees, Rt Hon Merlyn


Kinnock, Rt Hon Neil
Reid, John


Kirkwood, Archy
Richardson, Ms Jo


Lambie, David
Roberts, Allan (Bootle)


Lamond, James
Robertson, George


Leadbitter, Ted
Robinson, Geoffrey


Leighton, Ron
Rooker, Jeff


Lestor, Miss Joan (Eccles)
Ross, Ernie (Dundee W)


Lewis, Terry
Ross, William (Londonderry E)


Litherland, Robert
Rowlands, Ted


Livingstone, Ken
Ruddock, Ms Joan


Livsey, Richard
Salmond, Alex


Lloyd, Tony (Stretford)
Sedgemore, Brian


Lofthouse, Geoffrey
Sheerman, Barry


Loyden, Eddie
Sheldon, Rt Hon Robert


McAllion, John
Shore, Rt Hon Peter


McAvoy, Tom
Short, Clare


McCartney, Ian
Skinner, Dennis


McCusker, Harold
Smith, Andrew (Oxford E)


Macdonald, Calum
Smith, C. (Isl'ton &amp; F'bury)


McKelvey, William
Smith, Rt Hon J. (Monk'ds E)


McLeish, Henry
Smyth, Rev Martin (Belfast S)


Maclennan, Robert
Snape, Peter


McNamara, Kevin
Soley, Clive


McTaggart, Bob
Spearing, Nigel


McWilliam, John
Steel, Rt Hon David


Madden, Max
Steinberg, Gerald


Mahon, Mrs Alice
Stott, Roger


Marshall, David (Shettleston)
Strang, Gavin


Marshall, Jim (Leicester S)
Straw, Jack


Martin, Michael (Springburn)
Taylor, Mrs Ann (Dewsbury)


Martlew, Eric
Taylor, Matthew (Truro)


Maxton, John
Thomas, Dafydd Elis


Meacher, Michael
Thompson, Jack (Wansbeck)


Meale, Alan
Turner, Dennis


Michael, Alun
Vaz, Keith


Michie, Bill (Sheffield Heeley)
Walker, A. Cecil (Belfast N)


Millan, Rt Hon Bruce
Wall, Pat


Mitchell, Austin (G't Grimsby)
Wallace, James


Molyneaux, Rt Hon James
Walley, Ms Joan


Moonie, Dr Lewis
Wardell, Gareth (Gower)


Morley, Elliott
Wareing, Robert N.


Morris, Rt Hon A (W'shawe)
Welsh, Andrew (Angus E)


Morris, Rt Hon J (Aberavon)
Welsh, Michael (Doncaster N)


Mowlam, Marjorie
Wigley, Dafydd


Mullin, Chris
Williams, Rt Hon A. J.


Nellist, Dave
Williams, Alan W. (Carm'then)


Oakes, Rt Hon Gordon
Wilson, Brian


O'Brien, William
Winnick, David


Orme, Rt Hon Stanley
Wise, Mrs Audrey


Patchett, Terry
Worthington, Anthony


Pendry, Tom
Young, David (Bolton SE)


Pike, Peter



Powell, Ray (Ogmore)
Tellers for the Noes:


Primarolo, Ms Dawn
Mr. Frank Cook and


Quin, Ms Joyce
Mr. Allen McKay.

Question accordingly agreed to.

MR. SPEAKER forthwith declared the main Question, as amended, to be agreed to.

Resolved,
That this House applauds the achievement of the National Health Service in providing a record level of patient care; recognises that this achievement rests on the substantial additional funds from the taxpayer which a strong economy has made possible and which has supported the dedicated work of the National Health Service staff; and welcomes the Government's continued commitment to the most effective use of all the Service's growing resources to bring about a further rise in the standard of health care, both in hospitals and in the community.

Rating and Valuation (Scotland)

Mr. Archy Kirkwood: I beg to move,
That an humble Address be presented to Her Majesty, praying that the Non-Domestic Rates and Community Charges (Timetable) (Scotland) Regulations 1987 (S.I., 1987, No. 2167), dated 15th December 1987, a copy of which was laid before this House on 17th December, be annulled.
With your permission, Mr. Speaker, I understand that it will be convenient for the House to deal with the second motion:
That an humble Address be presented to Her Majesty, praying that the Abolition of Domestic Rates (Domestic and Part Residential Subjects) (Scotland) Regulations 1987 (S.I., 1987, No. 2179), dated 16th December 1987, a copy of which was laid before this House on 18th December, be annulled.
The first statutory instrument deals with the timetable for the implementation of the poll tax and the second deals with domestic and part residential subjects. Because the abolition of the rating system does not extend to non-domestic rates, the valuation roll will have to be maintained for non-domestic premises. The regulations dealing with residential and part residential subjects address that problem.
The regulations are technical and fairly detailed. I confess that I had some difficulty making sense of the regulations on domestic and part residential subjects. It is perverse of the parliamentary draftsmen to produce regulations of this complexity. It is difficult to make sense of them. I am sure it must have been possible to use plainer English to explain what the regulations were setting out to do. The regulations are the first of their kind to be discussed on the Floor of the House, and it is in the interests of all hon. Members that the regulations to implement the community charge provisions are fully discussed, because, although they are detailed and technical, they are very important. There are no fewer than 70 matters in the primary legislation to be discussed and dealt with by way of regulations, and these are the first two sets—dealing with domestic and part residential subjects and the timetable dates for the enactment provisions.
There are a number of major regulations still outstanding. We have not yet even seen them in draft form. They include statutory instruments to deal with the question of how students are to be provided for under the community charge, registration and appeals, although we have seen a draft regulation on that, the collection procedures, the revenue support grant and the vital matter of the rebate system.
With regard to what we have been able to see and the extent of the preparations that the Government have made for the regulations and draft regulations, there is a fear that the Government will not be able legally to collect the charge on 1 April 1989.

Mr. John Home Robertson: That may be a good thing.

Mr. Kirkwood: Even if they are able to collect the charge, they may simply be pushing the hassle, confusion and chaos further down the line into the hands of local authorities, because, although the regulations may be in place, the Government are still unable to give local authorities and registration officers and those organizing

the appeal systems that must be put behind the primary and secondary legislation a proper chance to implement the system in a sensible and thought-out manner.
The reality of the background to these first regulations is that the Government are not at this stage properly organised to implement the charge sensibly.
As I have already said, the abolition of the rating system does not extend to non-domestic rates, so the valuation roll will have to be maintained for non-domestic or commercial premises. Paragraphs 3 and 4 of the Abolition of Domestic Rates (Domestic and Part Residential Subjects) (Scotland) Regulations define exactly what will stay on the valuation roll, and is therefore liable for non-domestic rates, and what, on the other hand, will be deleted from it, and its residents, therefore, liable for the poll tax.
In the main, the purpose of the domestic and part residential subjects regulations is fairly straightforward. They remove from the roll private car ports, garages, sheds and ancillary buildings to sheltered accommodation. On a non-domestic basis, caravans and huts that are not used as primary residences for the whole year are being left on the valuation roll.
There are four or five questions to which I should like the Minister to address his mind. First—I am sure that he is familiar with this point, because it was raised by the Scottish Council for Single Homeless—is the question of definitions. The view that is taken by those who follow these matters closely north of the border is that an opportunity has been missed to revise comprehensively a host of definitions included in the regulations, which flow from the primary legislation on the community charge.
It is important to recognise that these regulations provided an opportunity to update definitions in line with current thinking and practice. For example, in the regulations definitions of the words "hostel" and "residential care home" serve to reinforce the idea that an individual should be treated differently just because he or she happens to live in a certain category of accommodation by choice or necessity. The logic behind the poll tax legislation is that when exemptions and exceptions are being considered, the decision should be based on an individual's present circumstances rather than the type of property in which he or she lives.
It is surprising to hear the Department's view, that if new definitions had been adopted and this opportunity had been taken to clarify these matters and bring the thinking up to date, it would have served to confuse matters. The evidence is to the contrary. The Scottish Development Department, the Housing Corporation and other authorities have begun to move away from traditional, old-fashioned definitions in their dealings with and guidance to local authorities and housing associations.
Let me give the Minister an example of the possible results. Under the definitions in the regulations, most of the best-supported accommodation provided by housing associations would be defined as "hostels". We know that many hostels are well run and do a good job. However, that definition links accommodation schemes provided by housing associations with the image of the very worst type of hostel. Similarly, community homes, satellite, supported, core and cluster housing could be classed as hostels. I am not sure whether that is a sensible way to proceed, and I believe that an important opportunity has actually been missed.
The Minister will also be aware that a "residential care home" as defined in the regulations could be so small as to provide home for only two people. Indeed, I have had examples of this kind in my constituency. Such residents would be exempt from the poll tax under the existing regulations. I believe that that makes a mockery of the care in the community concept, because those residents will be treated differently, despite the fact that they are encouraged to be full, ordinary members of the community.
I seek an assurance from the Minister that we will have a proper and correct assessment of properties. The Minister should give us the commitment that guidance instructions will be given to registration officers to examine the individual circumstances of premises and residents to ensure that the recorded valuation will in fact be "non-domestic". Indeed, the officers should not necessarily assume that the existing recorded valuation is always correct. Blanket decisions about categories of properties should not be made given the variation in valuation and rating practices. The Minister will be aware that there is a widely different and inconsistent approach to discretionary rates relief taken in Scotland within the different regional areas. It is not good enough if the registration officers simply accept the definitions and classifications that have served the rating system in the past.
There is also much concern regarding communal areas in sheltered housing. I am sure that the Minister is aware of that concern because the Scottish Council for Single Homeless has also raised the matter with the Scottish Office. We recognise that the regulations have been changed from the earlier draft to ensure that common rooms in sheltered housing developments for the elderly are excluded from rates, and that is welcome. However, regulation 31(c) specifies that the provision applies only to sheltered housing for the elderly.
It is not clear whether all other types of sheltered homes and schemes, for example for the mentally handicapped, are covered by legislation such as the Rating (Disabled Persons) Act 1978. I believe that the whole question of shared facilities and other concepts related to sheltered housing should not simply refer to physical design features. I believe that the facilities could include a shared support worker. I believe that those matters should be clarified. Where communal areas are rated separately, residents would have to pay both the poll tax and the rates for that area.
Another concern that merits consideration is the question of live-in staff in residential accommodation. [HON. MEMBERS: "Oh!"] I am not surprised that this matter was anticipated, because the Labour party has followed it carefully. If the Oppostion start teasing me about what I may or may not be doing this evening, I may start teasing them about what they did or did not do to get this debate. —[Interruption.] I expected the frisson of antipathy that is coming from the Labour Front Bench.

Mr. Home Robertson: Is the hon. Gentleman going to speak to the hon. Member for Caithness and Sutherland (Mr. Maclennan)?

Mr. Kirkwood: Do not tempt me.
The live-in staff in residential accommodation will be expected to pay the personal community charge. In certain

circumstances that would be fairly simple to administer. Many buildings have a separate warden's flat or house and that flat or house would not be included in the rateable value of the residential establishment. However, matters will be much more complicated in cases where one or two staff share a house with two or three people with special needs. Assessors should use objective criteria in determining what proportion of the rateable value should be deducted from the total when certain facilities are shared. It would help if the Minister would clarify that matter.
There is a real worry about the impact of the regulations on voluntary organisations and charities, which have enjoyed relief under the rating system. The new provisions will have a serious effect on them. Some voluntary or charitable institutions that benefit from exemptions under the rating system will get clobbered under the poll tax because they will be expected to pay the community charge for each of their workers. That will significantly increase the costs of some charities that run charitable homes to look after people who are mentally handicapped or mentally ill. That runs counter to the Government's stated policy of trying to switch from the state to the voluntary sector and from tax to charitable donations, which is part of the Government's political ambition. Many small charities doing very valuable work may be forced out of business by the extra on-cost of paying the community charge for members of staff.
On the timetable provisions, the Minister owes the House and local authorities an assurance that, if he is to bring forward the timetable for the setting of the dates by which they must achieve targets—for example, the date by which they must issue bills to enable people to pay the community charge in 12 monthly instalments — his Department will meet its own targets in time to allow them to meet those deadlines. The local authorities and rating authorities that collect and enforce the charge depend on many decisions and announcements made by the Minister's Department. Therefore, it is essential that he assures us that, if the process is to be brought forward by five weeks, he will ensure that his Department's work is done in time to allow local authorities to make the necessary decisions in proper order.
These are technical matters and it takes a lot of reading and careful study to understand them. I have tried to simplify them as much as I can. I think that the Minister will accept that the regulations are important. They are the first of many, and it is right for the House to spend an hour making sure that the Government understand the fears and apprehensions of those north of the border who are involved in these matters before the Minister gives the Government's view on the operation of the regulations.

Mr. Allan Stewart: I agree with the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) that these are important regulations, and I have no doubt that my hon. Friend the Minister will answer the hon. Gentleman's detailed questions. The hon. Gentleman has undoubtedly done a considerable amount of research.
The prayer carries the names of a number of hon. Members, headed by the right hon. Member for Tweeddale, Ettrick and Lauderdale (Mr. Steel), the leader of the Liberal party, and the hon. Member for Caithness and Sutherland (Mr. Maclennan), who were both present


for the last vote. It is a disgrace and an insult to the people of Scotland that hon. Members should put their names at the top of a prayer on a matter of importance to the people of Scotland and, having been present for our proceedings before this debate, should not even have the courtesy to stay for a few minutes to listen to the hon. Member for Roxburgh and Berwickshire.
It would have been of assistance for the House to know whether this was one subject on which the Social Democratic party and the Liberal party agreed. I hope that this short debate will also enable the Scottish National party and the Labour party—in addition to answering detailed questions about the regulations—to make their policies clear on the implementation of the community charge.
The House may have been puzzled to see early-day motion 503, in the names of several Opposition Members, which states:
That this House condemns the Scottish National Party for calling for a campaign of non-registration for, and nonpayment of, the poll tax".
That has been amended by the hon. Members for Angus, East (Mr. Welsh) and for Banff and Buchan (Mr. Salmond). I think that is the first time that two thirds of the parliamentary representatives of that party have condemned that party on the Order Paper.
As I understood it, that was the policy of the Labour party, or at least of a substantial number of people who are leading spokesmen of that party, such as Mr. Michael Conochie, and others. However, I appreciate that that might not necessarily be the policy of the hon. Member for Glasgow, Garscadden (Mr. Dewar). This debate therefore gives him an opportunity to clarify his position.
Turning in detail to the regulations, I should like to ask the Minister a question about regulation 4 of statutory instrument No. 145, which specifies the date by which district councils must give certain information to regional councils. What will happen if, regrettably, they do not? My hon. Friend will be aware that several Labour-controlled district councils have intimated that they will not cooperate with the community charge legislation. One hopes that common sense will eventually prevail in those district councils, but that may not be the case. What happens if they do not co-operate with these and other regulations? I put forward the fairly simple suggestion that my hon. Friend should ensure that they do not receive revenue from the community charge unless they co-operate. The revenue could be held by the regional councils until they do co-operate. That seems a fairly simple financial incentive, which would doubtless be effective.
Finally, I welcome the regulations for another reason. They show that, despite some disinformation to the contrary, the programme for the implementation of the community charge in Scotland is on target. There is no doubt that many people are trying to confuse the people of Scotland by suggesting that in some way or another the community charge will not replace domestic rates on the timetable as laid down in the Abolition of Domestic Rates Etc. (Scotland) Act 1987. As the House knows, it is of considerable importance to the Eastwood constituency that the domestic rating system is abolished and replaced by the community charge. I congratulate my hon. Friend on sticking to the timetable.

Mr. Donald Dewar: We are considering two instruments tonight which relate to the poll tax. That gives them a certain importance and reflected notoriety. They are highly technical, but relate to matters of substance.
The first is the timetable for implementation. It is perhaps a reminder of the complexity of the organisation that lies behind what the Government always represent as a simple concept—a flat-rate personal tax. They ask us to forget the joys of the water rate, the non-domestic sewage rate—the collective standard and personal poll tax — all of which will remain to plague, fester and create administrative difficulties. When the Minister of State is dead and gone — I am talking only of his political death — few will shower blessings on his memory.
It is a difficult first year for local government. If the timetable is to be held to, a great deal of activity must be crammed into a very short space of time. Canvassing—that famous exercise that takes us from door to door, daily and relentlessly, through the streets of Scotland—is, I understand, due to start on 1 April, and to be concluded by 1 October. It is a bit difficult to know how this will work, because we have not the necessary regulations in which the details are laid out — which is remarkable, coming from a Government who are always talking about the need to make haste. What we do know, however, is that ratepayers and taxpayers are being asked to take on considerable additional burdens as they hire staff, buy computers and organise all the paraphernalia of collection. Oppression, I fear, is built into the very system.
The order lays down that poll tax bills must be out by 31 March in any year. That will start a massive paper chase the like of which we have seldom seen in Scotland. It was, I believe, the report by the Chartered Institute of Public Finance and Accountancy that suggested that, if payment was organised by the normal instalment method, it could mean some 47 million bills anually being spewed out—if that is not too inelegant a phrase—by the administrative machine.
I recognise that there will be a lengthened timetable if this ridiculous tax is forced through. People will pay by 12 instalments, rather than the 10 that are normally paid under the rating system. There seems little leeway in the dates that have been set out. If mishaps or difficulties occur, or, indeed, if it is not possible to get it all ready in time, the whole system will be in real difficulties.
I am a little curious about one point. We are being told that bills must be out by 31 March: there are deadlines here and deadlines there for unfortunate local government. There are, however, few signs of deadlines for the Secretary of State. I gather, for example, that he has declined a pressing invitation to set a deadline for the time by which he must produce the rate support grant settlement—which, after all, is an essential starting point for those who must calculate the poll tax. As always, the Secretary of State seems to be taking a somewhat "Prussian corporal" approach to the administrative activities of local government, while remaining fancy-free himself. That, I fear, is all too typical.
The second instrument is, perhaps, more interesting. It is certainly more recherché. A fine example of administrative nit-picking, it will delight any one of the substantial number of barrack-room lawyers who can


usually be found in parliamentary or other company. Indeed, when I come to think of it, not just barrack-room lawyers, but professional lawyers as well will obtain considerable entertainment from the prospects.
I thought that the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) handled the complexities remarkably smoothly; however, it may be that in recent days he has had plenty of experience of obscure and Delphic documents, and I have some sympathy with him. My fear is that people will be invited to plunge into a jungle — a jungle in which many an administrator will disappear without trace.
Let me say in passing that I see with a certain sadness that all the work about which we heard — all the arguments about the definitions of a bicycle, and whether four wheels were good but two wheels were better—has come to naught. There has been a masterly compromise: we need not decide on the number of wheels, because in the regulations the bicycle has become a cycle. I suppose that that shows a certain amount of mental agility. Indeed, it is probably the most useful thing that the Minister of State has done in the past three months.
In any event, I predict that the regulations will be an outing for the vexatious litigant. Some points have already been raised by the hon. Member for Roxburgh and Berwickshire. He was using, as I have used, some very useful briefing material that came from COSLA and from the Scottish Council for Single Homeless. It points to many of the difficulties. They are marginal difficulties. Many people may not bother to chase up these points; they will shrug their shoulders and accept the broad brush approach. But if I remember the obsessive interest in rating law that has always been shown by the most unlikely people, I suspect that that is an unsafe assumption.
It is perfectly straightforward that a garage which is detached from a domestic property, a lock-up perhaps some distance away, may still be treated as domestic and therefore outside the rating system when it is merely used to house the family car or the legendary cycle. But without expending much ingenuity, one can think of many difficult halfway—I was about to say "houses" but I suppose a better word would be "garages". Let us say that it is used, for example, for a taxi or to garage a delivery van. I know many people who have a vehicle which they use at their work to deliver goods; then they take it home and run it into the family garage at the end of the working day. Let us assume that a driving instructor uses the family car on a part-time basis for his trade and garages it in a detached lock-up garage. Is that part of the domestic hereditament, or is it commercial, in which case it would remain in the rating system and ought to be rated? I do not know whether there will be a great deal of litigation on such questions, but the possibilities are almost endless.
Then we have the whole question of the huts, the bothies and the doocots which the House will remember remain commercial properties, which are not considered to be domestic and which are therefore rated. In paragraph 4 (c) of the abolition regulations, caravans are not to be classed as domestic and within the ambit of the poll tax if they are
not allowed to be used for human habitation throughout the whole year".
I am not sure what "throughout the whole year" means. What happens if the caravan is used throughout the whole year even if it is not technically allowed to be so used? At

that point, does the caravan become domestic and subject to poll tax? Perhaps the Minister could say a word about whether caravans will be rateable properties.

Mr. Geoffrey Dickens: I understood that the local authority would have control over the rating of caravans in its area anti that if a caravan was used only for holidays, weekends and so on, it could be charged up to two whole community charges. The likelihood is that it would be half a community charge. Clearly, if somebody is living the whole year in a caravan, that is his home and it is proper for the community charge to be levied. That seems sensible to me.

Mr. Dewar: I have every sympathy with the hon. Member. His confusion on this occasion is more understandable than it is on others. If he reads paragraph 4 of the abolition regulations he will see that caravans are not treated as a homogeneous mass but that there are subspecies of caravan in the world of the poll tax. It is difficult sometimes to know what one is looking at. One may see a box upon wheels. Would the hon. Gentleman know the difference between caravans which are on a fixed site and on which the dwellers will helve to pay a poll tax and caravans accepted under regulation 4, which
in accordance with any licence or planning permission … are not allowed to be used for human habitation throughout the whole year"?
If a person lives in one of those, he is not subject to the poll tax, but presumably the caravan is liable for rating.
So the song goes on endlessly. It will become a nightmare from which you, Mr. Deputy Speaker, and I would run away and pass by on the other side, but if we lived in such a caravan we would have problems. This tiny matter illustrates the problems which will be coming shortly to the constituency of the hon. Member for Littleborough and Saddleworth (Mr. Dickens) if he does not do something about it in the course of the current legislation.
I also draw the attention of the House to the problem of communal dwellings, which are rated and which are within the domestic sector and not rated. The hon. Member for Roxburgh and Berwickshire very fairly drew attention to some problems, and I have much sympathy with the points that were made originally by the Scottish Council for Single Homeless about hostels, lodging houses and refuges. They will be liable to the community charge. There is also a plethora of other types of residential facility that will be classed for rating purposes.

Mr. Alistair Darling: I wonder whether, in considering this dog's breakfast of an order, my hon. Friend will speculate on what are substantially different facilities when considering sheltered housing premises? Will he not agree with me that this dog's breakfast legislation will benefit only lawyers? Perhaps the right hon. and learned Secretary of State for Scotland and the hon. and perhaps not quite so learned Member for Edinburgh, West (Lord James Douglas-Hamilton) are anticipating a return to practice in 1990 or 1991, when they will have to get to grips with this legislation.

Mr. Dewar: In the presence of learned counsel, I would not disagree with arty of those propositions. It is a fair point that there are great problems with definition, and the position will be confused and ambiguous at times.
I shall remind the House of what was said by the Scottish Council for Single Homeless, which has much experience. In its view, the regulations
will lead to distress for individual payees, more appeals to the courts, greater difficulty in implementing the legislation and inevitable amendments to the regulations, and possibly the Act in the very near future, at considerable expense and bureaucratic hassle for all concerned.
That is an excellent phrase that we might take into the parliamentary vocabulary — "bureaucratic hassle". The case has been well made out.
Regulation 3(1)(c) deals with communal sheltered houses, and lists a series of sheltered houses with communal facilities such as a lounge or dining facility used in common; they will not be rated, but the occupants will pay a poll tax on the dwelling house part of the complex. That is sensible and is welcomed by everyone. But the point has been made, and I want to stress it—the hon. Member for Roxburgh and Berwickshire mentioned it in passing—that the concession is tied, or appears to be tied, to sheltered housing premises for the elderly.
There is also sheltered housing for the mentally handicapped. In my constituency, there is a special complex of scatter flats for the young single homeless. It is a series of individual dwellings with communal lounges and social facilities attached. If one takes the restriction to sheltered housing to refer to the elderly, one might well envisage a situation where other groups pay poll tax individually as occupants of the properties and are also responsible on some basis for the rates levied on the common parts.
Paragraph 3(1)(d) provides that staff houses attached to residential accommodation are to be treated as domestic premises, and the inmate will pay a poll tax. The staff house will not be rated in the same way as the rest of the premises. That is simple enough in relation to a warden's flat where the warden will pay poll tax in the way that I have described. It is self-evidently complicated, and perhaps on the margins of the debate, but it might become important.
What happens when a group of, say, handicapped people is living communally with staff who are helping them and giving them support—living in a room but sharing their communal facilities? There might be a kitchen that clearly has to be rated because it is part of a residential home that is regarded as being outwith the poll tax system. The warden, who is paying a poll tax, uses that kitchen. Will the kitchen's rateable value be reduced to take account of the use of that kitchen by the warden? How will that apportionment be made, and what criteria will be applied? No doubt the Minister will be glad to comment on that kind of important point when he sums up.
I have been dealing with some detailed points, but sometimes principles of importance lurk behind even detailed points. We are talking about homes for the elderly—nursing homes—and the fact that these are going to be rated under the new system. What has come out of that is the much commented on, and rightly commented on, extraordinary distortion whereby, if an elderly person is living at home, he or she will pay the poll tax, while if he or she is living in a nursing home or a home for the elderly, he or she will not have to pay the poll tax.
The present system is neutral. There is no penalty for offering shelter and succour. But now we are building a

disincentive into the system. I would not insult anyone by suggesting that that disincentive is likely to stop someone who has a feeling of duty towards an elderly relative doing that duty, but it means that the relative will have a financial reason for hesitating. The family unit will have to bear an additional financial burden that it does not have to pay under the rating system. That is an unhappy consequence that cannot be easily shrugged off.
I am aware that there has been correspondence on the issue. I have here a letter from the Scottish Office dated 18 December 1987, from a Mr. Muir Russell, addressed to the Convention of Scottish Local Authorities. Dealing with exemptions, he says that any other approach than the present flat-rate approach
would weaken the concept of the community charge as a personal tax levied on all adults over the age 18 … The justification for exempting residents of nursing homes, residential care homes, and hostels providing an equivalent level of care is that they are by reason of their physical or mental frailty unable to take an active part in the local community, to the extent that the argument for imposing the personal community charge as a means of increasing local accountability does not apply.
But exactly the same sort of people who have not had to go into a residential home but are being maintained at home, with exactly the same degree of frailty, exactly the same mental and physical difficulties, are going to be asked to pay the poll tax. It does seem to me that this is a quite miserable anomaly, and one of which the House should not be proud.
We have built into the system, as the Secretary of State knows, for example, a method of certification for the severely mentally handicapped. I do not think that very many of us like it, but at least there is there an exemption when a doctor is prepared to certify that a certain situation exists in regard to his patient. I would not have thought that it would be beyond the bounds of possibility to extend that to those who are frail, who have physical problems, and are being maintained, often at enormous cost and sacrifice, by their families. [Interruption.]
My hon. Friend the Member for Jarrow (Mr. Dixon) says that that is not a good road to go along. I am perfectly prepared to have a debate, but I think that he would agree with me that, whether or not that is the right road, a road ought to be found. On that I think there would be total unanimity. The present anomaly, whereby people are asked to pay because they remain with their families, although they may be physically in the same situation as those who are in a home and have been exempted, is totally unsatisfactory.
I will leave it there, because one or two other hon. Members will obviously wish to speak. I believe that this is an unpleasant series of regulations. I believe that it is unjust and unacceptable. It is part of the fabric of the implementation of the poll tax, which will be a low-yield, high-cost, totally unwanted tax. In the last day or two, the Secretary of State has been saying a great deal about the virtues of listening to public opinion. He has told us that in education he listened to the almost universal condemnation and rightly—he makes a virtue of it—abandoned most of the plans that he had put on the table for discussion.
I am prepared to give the right hon. and learned Gentleman credit for that, if he promises that it will be a precedent. I suggest to him that there is no area where condemnation is more universal or opposition more widespread than that of the poll tax. We oppose it root and


branch. We believe that he is becoming increasingly isolated and alienated. In debates such as this, we will continue our attempt at least to make contact with the beleaguered garrison in the Scottish Office. I believe, and I think that I speak for most people in Scotland, that the whole miserable and misguided exercise should be abandoned.

Mr. Alex Salmond: The statutory instruments should be rejected, not because they are technically incorrect but because they are democratically indefensible.
The debate takes place against the backcloth of the complete rejection of the poll tax by the Scottish population. In the last Parliament the vast majority of Scottish Members of Parliament voted against the legislation. If these statutory instruments are voted on tonight, an even larger majority of Scottish Members of Parliament will vote for their annulment. The issue has been tested in Scotland at the general election and the Conservative party's case in favour of the poll tax was found wanting.
It is possible to implement the poll tax. It is clumsy, convoluted and expensive. It will cost about an additional £25 million, twice the extra resources given to the Scottish Health Service at the end of last year. It is possible to implement the poll tax, but that does not make it right, nor does it make it certain.
There will be a large measure of support for a campaign of non-payment against the poll tax. I was interested in a BBC television programme on Friday night, where, despite the joint efforts of the hon. Member for Stirling (Mr. Forsyth) and the right hon. and learned Member for Monklands, East (Mr. Smith) in arguing for payment of the poll tax, some 50 per cent. of the audience said that they were prepared to consider non-payment.
There will be a campaign of non-payment against the poll tax. The only question is whether it will be organised and effective or isolated and then suppressed.

Mr. Deputy Speaker (Mr. Harold Walker): Order. The hon. Gentleman is taking the debate very wide of the regulations before the House. We cannot have a general debate about the community charge. I hope that he will address his remarks to the regulations.

Mr. Salmond: I was arguing that the statutory instruments should be annulled because democratically they are in question.

Mr. Harry Ewing: Will the hon. Gentleman give way?

Mr. Salmond: I shall extend to the hon. Gentleman the courtesy that he did not extend to me last week in the debate on the Select Committee on Scottish Affairs.

Mr. Ewing: I did not do too badly last week. I extended the courtesy to two or three Members, and that is not bad going on any terms.
The hon. Gentleman is arguing that there should be a campaign of non-payment of the community charge. If that is the advice that he is giving to the people of Scotland, is he committing Gordon Wilson, the chairman of the Scottish National party and a lawyer, and any other lawyer in the SNP, to give their services free of charge to any person in Scotland who accepts the advice to break the law and then finds himself in court?

Mr. Salmond: If the hon. Gentleman scrutinises the legislation, he will find that one of the great problems with it is that there is no defence. The SNP is committed to providing a spearhead and leadership.
The question is not whether there will be a campaign of non-payment; it is whether it will be organised.

Mr. Deputy Speaker: Order. That may well be the question, but not for our proceedings at this time of night. The hon. Gentleman should address his remarks more: closely to the regulations.

Mr. Salmond: It is legitimate to argue against the statutory instruments because they are democratically in question.

Mr. Deputy Speaker: Order. It is in order to argue against the statutory instruments as long as the hon. Gentleman confines his arguments to their content. That is what he is not doing, and I hope that he will.

Mr. Salmond: I am arguing reasonably that the statutory instruments should be annulled because they are democratically in question. I am seeking to build the case to show why they are democratically in question in Scotland.
To answer the hon. Member for Falkirk, East (Mr. Ewing), the Scottish National party has argued that a campaign must be waged against the poll tax. We offered the leadership of such a campaign to COSLA and the STUC. The response that we received from those organisations was less than favourable, although I understand that the STUC's position is now changing.
There are two requirements for such a campaign to be successful. First, it must be organised. There is no reason to believe—

Mr. Deputy Speaker: Order. The hon. Gentleman is paying no regard to the advice that I have offered him. Either he must return to the substance of the regulations, or I must ask him to resume his seat.

Mr. Salmond: Thank you, Mr. Deputy Speaker.
I close my remarks by saying that the campaign must be organised effectively. Secondly, there must be—

Mr. Deputy Speaker: Order. The hon. Gentleman is clearly completely disregarding my advice. I must therefore advise him to resume his seat. I call the hon. Member for Tayside, North (Mr. Walker.)

Mr. Salmond: rose—

Mr. Deputy Speaker: Order. The hon. Gentleman must not challenge my ruling. I have instructed him to resume his seat, and that he must now do.

Mr. Salmond: rose—

Mr. Deputy Speaker: Order. I ordered the hon. Gentleman to resume his seat when I was on my feet. If he does not respond to the instruction that I have given him, I shall have no alternative but to exercise my disciplinary powers.

Mr. Bill Walker: The hon. Member for Glasgow, Garscadden (Mr. Dewar) properly drew the House's attention to the fact that barrack-room lawyers might well emerge. What has already happened twice today shows that in Scottish affairs we have not only barrack-room lawyers but people who are determined to destroy any sort of objective debate—whatever the risks.
The speech by the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) was fascinating. The House will certainly feel that we were fortunate that the Liberals were not responsible for drawing up the regulations. The hon. Gentleman said that definitions give them problems. We know that the Liberals and their SDP colleagues—they are noticeable by their absence this evening, and they were absent for yesterday's debate, too—find difficulty in reaching any kind of agreement. The hon. Gentleman's speech clearly showed that if they were ever given the opportunity to bring forward regulations, in the House or anywhere else, they would spend all their time talking about their disagreements and get nowhere.
The regulations are essential. They are part of the programme that we need if we are to move towards getting the community charge into operation by the given date. The hon. Member for Garscadden rightly drew attention to areas that he believed needed to be clarified, which is what the debate should be about.
The hon. Member for Garscadden was right, too, to draw attention to the problems of caravans. Their position must be clarified. But the hon. Gentleman knows only too well that, in the past two Parliaments, we have had to deal with and amend caravan legislation brought in by the Labour Government. Caravans have always caused problems of clear definition in matters of rating.
I welcome the timetable, which clearly shows by what date and by whom things must be done. It will make it possible for local authorities to plan properly and meet the deadlines. No one has ever suggested that the transition from the rates to the community charge would be easy. Substantial changes such as this are never easy. Therefore, it is right to include the timetable in the regulations.
I welcome the regulations, because the community charge will give the country a real opportunity, based on the regulations and the timetable, to introduce a measure that will be seen to be fair, just and preferable for Scotland.

The Minister of State, Scottish Office (Mr. Ian Lang): We are all in the debt of the Liberal party for initiating the debate. It is appropriate that Liberal Members should take such a close interest in praying at a time such as this. Of course, I had hoped that they might favour us by revealing a policy. I recall that, throughout the consideration of the Bill in Committee — the hon. Member for Glasgow, Cathcart (Mr. Maxton) will remember this vividly—in 125 hours the hon. Member for Caithness and Sutherland (Mr. Maclennan), who is not in his place, utterly failed to deliver even the tiniest nuance of what his policies would be. He said that he could do business with me. That was a greater compliment than I knew at the time. He has now revealed that he can do business with almost nobody else.
It has been an interesting debate, if only to reveal the fact that the hon. Member for Banff and Buchan (Mr. Salmond), who wants the people of Scotland to break the law on the community charge, is not prepared to contemplate breaking the laws of the House.
The regulations are an important although essentially technical part of the process of implementing the community charge in Scotland. As the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) said, they are complicated. I shall try to simplify them.
It was indeed a pleasure to hear the subtlety of mind that the hon. Member for Glasgow, Garscadden (Mr. Dewar) deployed on this occasion. It gave us a tantalising glimpse of what we might have enjoyed in those 125 hours in Committee had he joined us. He mentioned a certain obsession with doocots. I hope that he is not contemplating paying his community charge in pieces of eight. If time permits, I shall try to cover some of the other points that he raised.
It may be helpful if I explain the policy background to the two sets of regulations. In doing so, I shall try to deal with the technical measures that have been raised. In regard to the domestic and part residential subject regulations, from 1 April next year the valuation roll will not include domestic subjects, and rates will no longer be paid on them. The basic definition of domestic subjects, which is set out in section 2 of the Abolition of Domestic Rates Etc. (Scotland) Act 1987, is dwelling houses. There is provision in that section for additions and exceptions to the definition, and the main purpose of the domestic subjects regulations is to set out such additions and exceptions in detail.
A particularly important effect of the regulations is to provide exemption from liability to pay a personal community charge for residents — other than resident members of staff—of private hospitals, nursing homes, residential care homes, and certain hostels providing an equivalent level of care. That is achieved by ensuring that the subjects, other than the accommodation used by resident staff, remain within the rating system so that, under section 8 of the 1987 Act, personal community charge liability does not arise. The regulations ensure that certain properties, such as beach chalets and holiday caravans, remain within the rating system to avoid liability to the standard community charge.
Many changes were made to the draft regulations in the light of responses to the consultation exercise, which involved bodies such has the Scottish Assessors Association, COSLA, the Royal Institution of Chartered Surveyors, the Law Society of Scotland, and many others. Most of the changes were of a technical nature. I draw the attention of the House to one substantive addition. The regulations, as made, provide for the removal from rating of the communal parts of sheltered housing developments. That point was raised by the hon. Member for Roxburgh and Berwickshire. He inquired whether that change would apply only to sheltered housing for the elderly. That is what the representations sought.
That removal was in response to a representation from the Scottish Federation of Housing Associations. Its argument was that, if individual sheltered housing units were to be removed from rating because they fell within the category of dwellinghouses, it would be inconsistent to leave within rating the communal areas — typically comprising laundries, common rooms, and guest rooms — since, for all practical purposes, such ancillary accommodation forms an integral part of the everyday living space available to residents for their exclusive use. That argument seemed to us to be entirely reasonable, and the regulations now give effect to the point in paragraph 1(c) of regulation 3.
Any comparison between the draft of the regulations and the regulations in the form as now made provides ample evidence that the consultation process was entirely genuine.
The regulations are also consistent with the explanations that we gave during the passage of the Abolition of Domestic Rates Etc. (Scotland) Bill last year of the intentions underlying the powers of prescription in clause 2 of the Bill, and also with the commitment that the Government gave that residents of nursing homes, residential care homes and similar establishments were to be exempted from having to pay the personal community charge through the mechanism of leaving such property subject to non-domestic rates.
The provisions of the timetable regulations are also essentially technical.

Mr. Dick Douglas: How can the Minister possibly justify the fact that if somebody is severely mentally handicapped and is in hospital he will be exempt from the personal community charge but that if a similar individual lives in the family home within the community he will have to go through the paraphernalia of vexatious and disturbing information-gathering in order to gain a similar exemption?

Mr. Lang: The hon. Gentleman attempts to clothe his point with an emotional coating by referring to the severely mentally handicapped. That is outwith the regulations. If somebody leaves hospital and returns home, he will be liable to rating.
As I have already said, the provisions of the timetable regulations are essentially technical. Their main importance lies in defining for local authorities the capability which needs to be built into the computer systems they are designing in terms of handling the information necessary for the setting of non-domestic rates and community charges, the issue of demand notices and so on.
The timetable contained in these regulations differs in detail from the corresponding requirements under the rating system. The main reason for this is that the normal method of payment of community charge will be 12 monthly instalments beginning in April each year, rather than the 10 monthly instalments beginning in May by which rates are payable. This means that decisions have to he taken and demand notices issued before the start of the financial year, so the process has to start somewhat earlier.
Our proposals were issued for consultation in mid-September last year. A number of detailed comments were made about relatively minor parts of the timetable, and account has been taken of these in the final version of the regulations.

Mr. John Maxton: I understand what the Minister is saying about the timetable and the programme, but how can local authorities or anybody else decide the billing processes and the computer systems when they have no idea about the particular rebate scheme that will govern the collection system? Does the Minister intend to make an announcement about that in the near future?

Mr. Lang: I assure the hon. Gentleman that we are in no way departing from the critical path for implementation of the regulations and provisions in the Abolition of Domestic Rates Etc. (Scotland) Act 1987. The programme allows plenty of time to deal with all those matters. The hon. Gentleman should bear in mind that the broad thrust of the system will not be so different from the broad thrust of the administration of domestic rates.
The only significant concern expressed related to the proposal in the consultation draft that there should be a

cut-off date in March for the issue of demand notices. Some of those consulted were concerned that this requirement would leave insufficient time for the work to be done, bearing in mind that there will be twice as many community charge payers as domestic ratepayers—hence the explanation of the increase in cost to which the hon. Member for Banff and Buchan referred.
In the final version of the regulations, the deadline was put back to 31 March, so that there are now two clear months to issue demand notices after the determination of the non-domestic rate and the community charges. I cannot believe that this provides insufficient time for local authorities to get the job done. We have, as I have already made clear, provided substantial additional resources for local authorities to acquire and install the necessary equipment to handle community charge registration, billing and collection and it is up to authorities to design systems which can meet the requirements of the new system in this as in other respects.
Last night the House debated the Rate Support Grant (Scotland) (No. 3) Order and approved the generous grant settlement for local authorities for 1988–89. During that debate there were calls for the abolition of guidelines and for the abolition of grant penalty—both inventions of previous Labour Governments. The introduction of the community charge will achieve both those objectives. It will introduce a system that will be fairer and that will create greater accountability between local authorities and the residents in their areas. It will force local authorities into the open and make them justify their spending levels to the electors who will have to pay them. That will create a new realism and responsibility, and that cannot come too soon.
We are well down the path, through the process of consultation, towards the smooth, orderly implementation of the community charge, on target and on time. The local authorities are quietly and competently getting on with the job of preparation. These two sets of regulations are two more milestones along that road, and I commend them to the House.

Mr. Kirkwood: I judge that the House would like to vote on this issue. I move therefore that the two instruments that we have been discussing be annulled, and I invite hon. Members to vote accordingly.

Mr. Deputy Speaker: Order. The House can vote on only one, and that is the first one on the Order Paper.

Question put:—

The House divided: Ayes 218, Noes 271.

Division No. 146]
[11.30 pm


AYES


Abbott, Ms Diane
Bermingham, Gerald


Adams, Allen (Paisley N)
Bidwell, Sydney


Allen, Graham
Blair, Tony


Archer, Rt Hon Peter
Blunkett, David


Armstrong, Ms Hilary
Boyes, Roland


Ashdown, Paddy
Bradley, Keith


Ashley, Rt Hon Jack
Bray, Dr Jeremy


Ashton, Joe
Brown, Gordon (D'mline E)


Banks, Tony (Newham NW)
Brown, Nicholas (Newcastle E)


Barnes, Harry (Derbyshire NE)
Brown, Ron (Edinburgh Leith)


Barron, Kevin
Buchan, Norman


Battle, John
Buckley, George


Beckett, Margaret
Caborn, Richard


Beith, A. J.
Callaghan, Jim


Bell, Stuart
Campbell, Ron (Blyth Valley)


Benn, Rt Hon Tony
Campbell-Savours, D. N.


Bennett, A. F. (D'nt'n &amp; R'dish)
Canavan, Dennis






Carlile, Alex (Mont'g)
John, Brynmor


Clark, Dr David (S Shields)
Johnston, Sir Russell


Clarke, Tom (Monklands W)
Jones, Barry (Alyn &amp; Deeside)


Clay, Bob
Jones, Martyn (Clwyd S W)


Clelland, David
Kaufman, Rt Hon Gerald


Clwyd, Mrs Ann
Kennedy, Charles


Cohen, Harry
Kirkwood, Archy


Coleman, Donald
Lambie, David


Cook, Frank (Stockton N)
Lamond, James


Cook, Robin (Livingston)
Leadbitter, Ted


Corbett, Robin
Leighton, Ron


Corbyn, Jeremy
Lestor, Miss Joan (Eccles)


Cousins, Jim
Lewis, Terry


Cox, Tom
Litherland, Robert


Crowther, Stan
Livingstone, Ken


Cryer, Bob
Livsey, Richard


Cummings, J.
Lloyd, Tony (Stretford)


Cunliffe, Lawrence
Lofthouse, Geoffrey


Dalyell, Tam
Loyden, Eddie


Darling, Alastair
McAllion, John


Davies, Rt Hon Denzil (Llanelli)
McAvoy, Tom


Davies, Ron (Caerphilly)
McCartney, Ian


Davis, Terry (B'ham Hodge H'l)
Macdonald, Calum


Dewar, Donald
McKay, Allen (Penistone)


Dixon, Don
McKelvey, William


Dobson, Frank
McLeish, Henry


Doran, Frank
McNamara, Kevin


Douglas, Dick
McTaggart, Bob


Dunnachie, James
McWilliam, John


Dunwoody, Hon Mrs Gwyneth
Madden, Max


Eadie, Alexander
Mahon, Mrs Alice


Eastham, Ken
Marshall, David (Shettleston)


Evans, John (St Helens N)
Marshall, Jim (Leicester S)


Ewing, Harry (Falkirk E)
Martin, Michael (Springburn)


Ewing, Mrs Margaret (Moray)
Martlew, Eric


Fatchett, Derek
Maxton, John


Faulds, Andrew
Meacher, Michael


Fearn, Ronald
Michael, Alun


Field, Frank (Birkenhead)
Michie, Bill (Sheffield Heeley)


Fields, Terry (L'pool B G'n)
Millan, Rt Hon Bruce


Fisher, Mark
Mitchell, Austin (G't Grimsby)


Flannery, Martin
Moonie, Dr Lewis


Foot, Rt Hon Michael
Morley, Elliott


Foster, Derek
Morris, Rt Hon A (W'shawe)


Foulkes, George
Morris, Rt Hon J (Aberavon)


Fraser, John
Mowlam, Marjorie


Fyfe, Mrs Maria
Mullin, Chris


Galbraith, Samuel
Nellist, Dave


Galloway, George
Oakes, Rt Hon Gordon


Garrett, John (Norwich South)
O'Brien, William


Garrett, Ted (Wallsend)
Orme, Rt Hon Stanley


George, Bruce
Patchett, Terry


Gilbert, Rt Hon Dr John
Pendry, Tom


Godman, Dr Norman A.
Pike, Peter


Golding, Mrs Llin
Powell, Ray (Ogmore)


Gordon, Ms Mildred
Primarolo, Ms Dawn


Grant, Bernie (Tottenham)
Quin, Ms Joyce


Griffiths, Nigel (Edinburgh S)
Radice, Giles


Griffiths, Win (Bridgend)
Randall, Stuart


Grocott, Bruce
Redmond, Martin


Hardy, Peter
Rees, Rt Hon Merlyn


Harman, Ms Harriet
Reid, John


Hattersley, Rt Hon Roy
Richardson, Ms Jo


Haynes, Frank
Roberts, Allan (Bootle)


Healey, Rt Hon Denis
Robertson, George


Heffer, Eric S.
Robinson, Geoffrey


Hinchliffe, David
Rooker, Jeff


Hogg, N. (C'nauld &amp; Kilsyth)
Ross, Ernie (Dundee W)


Holland, Stuart
Rowlands, Ted


Home Robertson, John
Ruddock, Ms Joan


Howarth, George (Knowsley N)
Salmond, Alex


Howells, Geraint
Sedgemore, Brian


Hoyle, Doug
Shore, Rt Hon Peter


Hughes, John (Coventry NE)
Short, Clare


Hughes, Robert (Aberdeen N)
Skinner, Dennis


Hughes, Roy (Newport E)
Smith, Andrew (Oxford E)


Hughes, Simon (Southwark)
Smith, C. (Isl'ton &amp; F'bury)


Illsley, Eric
Smith, Rt Hon J. (Monk'ds E)


Ingram, Adam
Snape, Peter


Janner, Greville
Soley, Clive





Spearing, Nigel
Wareing, Robert N.


Steinberg, Gerald
Welsh, Andrew (Angus E)


Stott, Roger
Welsh, Michael (Doncaster N)


Strang, Gavin
Williams, Rt Hon A. J.


Straw, Jack
Williams, Alan W. (Carm'then)


Taylor, Mrs Ann (Dewsbury)
Wilson, Brian


Taylor, Matthew (Truro)
Winnick, David


Thomas, Dafydd Elis
Wise, Mrs Audrey


Thompson, Jack (Wansbeck)
Worthington, Anthony


Turner, Dennis
Young, David (Bolton SE)


Walker, A. Cecil (Belfast N)



Wall, Pat
Tellers for the Ayes:


Walley, Ms Joan
Mr. James Wallace and


Warden, Gareth (Gower)
Mr. Malcolm Bruce.


NOES


Aitken, Jonathan
Curry, David


Alexander, Richard
Davies, Q. (Stamf'd &amp; Spald'g)


Alison, Rt Hon Michael
Davis, David (Boothferry)


Allason, Rupert
Day, Stephen


Amos, Alan
Devlin, Tim


Arbuthnot, James
Dickens, Geoffrey


Arnold, Tom (Hazel Grove)
Dicks, Terry


Ashby, David
Dorrell, Stephen


Aspinwall, Jack
Douglas-Hamilton, Lord James


Atkins, Robert
Dover, Den


Atkinson, David
Dunn, Bob


Baker, Rt Hon K. (Mole Valley)
Durant, Tony


Baker, Nicholas (Dorset N)
Eggar, Tim


Baldry, Tony
Emery, Sir Peter


Batiste, Spencer
Evans, David (Welwyn Hatf'd)


Beaumont-Dark, Anthony
Evennett, David


Bellingham, Henry
Fallon, Michael


Bendall, Vivian
Favell, Tony


Bennett, Nicholas (Pembroke)
Fenner, Dame Peggy


Bevan, David Gilroy
Field, Barry (Isle of Wight)


Blackburn, Dr John G.
Finsberg, Sir Geoffrey


Blaker, Rt Hon Sir Peter
Forman, Nigel


Body, Sir Richard
Forsyth, Michael (Stirling)


Bonsor, Sir Nicholas
Forth, Eric


Boscawen, Hon Robert
Fowler, Rt Hon Norman


Boswell, Tim
Franks, Cecil


Bottomley, Peter
Freeman, Roger


Bottomley, Mrs Virginia
French, Douglas


Bowden, A (Brighton K'pto'n)
Fry, Peter


Bowden, Gerald (Dulwich)
Gale, Roger


Bowis, John
Gardiner, George


Boyson, Rt Hon Dr Sir Rhodes
Garel-Jones, Tristan


Brandon-Bravo, Martin
Gill, Christopher


Brazier, Julian
Glyn, Dr Alan


Bright, Graham
Goodlad, Alastair


Brittan, Rt Hon Leon
Goodson-Wickes, Dr Charles


Brooke, Rt Hon Peter
Gorman, Mrs Teresa


Brown, Michael (Brigg &amp; Cl't's)
Gorst, John


Browne, John (Winchester)
Gow, Ian


Bruce, Ian (Dorset South)
Grant, Sir Anthony (CambsSW)


Buchanan-Smith, Rt Hon Alick
Greenway, Harry (Eating N)


Buck, Sir Antony
Greenway, John (Rydale)


Budgen, Nicholas
Gregory, Conal


Burns, Simon
Griffiths, Sir Eldon (Bury St E')


Burt, Alistair
Griffiths, Peter (Portsmouth N)


Butcher, John
Ground, Patrick


Butterfill, John
Grylls, Michael


Carlisle, John, (Luton N)
Hamilton, Neil (Tatton)


Carlisle, Kenneth (Lincoln)
Hampson, Dr Keith


Carrington, Matthew
Hanley, Jeremy


Carttiss, Michael
Hannam, John


Cash, William
Hargreaves, A. (B'ham H'll Gr')


Channon, Rt Hon Paul
Hargreaves, Ken (Hyndburn)


Chapman, Sydney
Harris, David


Chope, Christopher
Haselhurst, Alan


Clark, Sir W. (Croydon S)
Hawkins, Christopher


Clarke, Rt Hon K. (Rushcliffe)
Hayes, Jerry


Colvin, Michael
Hayhoe, Rt Hon Sir Barney


Conway, Derek
Hayward, Robert


Coombs, Anthony (Wyre F'rest)
Heathcoat-Amory, David


Coombs, Simon (Swindon)
Heddle, John


Cope, John
Heseltine, Rt Hon Michael


Couchman, James
Hicks, Mrs Maureen (Wolv' NE)


Cran, James
Hicks, Robert (Cornwall SE)






Higgins, Rt Hon Terence L.
Page, Richard


Hill, James
Paice, James


Hind, Kenneth
Parkinson, Rt Hon Cecil


Hogg, Hon Douglas (Gr'th'm)
Patnick, Irvine


Holt, Richard
Patten, Chris (Bath)


Hordern, Sir Peter
Patten, John (Oxford W)


Howard, Michael
Pawsey, James


Howarth, Alan (Strat'd-on-A)
Peacock, Mrs Elizabeth


Howarth, G. (Cannock &amp; B'wd)
Porter, Barry (Wirral S)


Howell, Ralph (North Norfolk)
Porter, David (Waveney)


Hunt, David (Wirral W)
Portillo, Michael


Hunt, John (Ravensbourne)
Price, Sir David


Hunter, Andrew
Raffan, Keith


Hurd, Rt Hon Douglas
Raison, Rt Hon Timothy


Irvine, Michael
Rathbone, Tim


Jack, Michael
Redwood, John


Jackson, Robert
Renton, Tim


Janman, Timothy
Rhodes James, Robert


Jessel, Toby
Rhys Williams, Sir Brandon


Johnson Smith, Sir Geoffrey
Riddick, Graham


Jones. Gwilym (Cardiff N)
Ridley, Rt Hon Nicholas


Jones, Robert B (Herts W)
Rifkind, Rt Hon Malcolm


Kellett-Bowman, Mrs Elaine
Roberts, Wyn (Conwy)


Key, Robert
Roe, Mrs Marion


King, Roger (B'ham N'thfield)
Rossi, Sir Hugh


Kirkhope, Timothy
Rost, Peter


Knapman, Roger
Rowe, Andrew


Knight, Greg (Derby North)
Rumbold, Mrs Angela


Knight, Dame Jill (Edgbaston)
Ryder, Richard


Knowles, Michael
Sackville, Hon Tom


Knox, David
Sainsbury, Hon Tim


Lamont, Rt Hon Norman
Sayeed, Jonathan


Lang, Ian
Shaw, David (Dover)


Latham, Michael
Shaw, Sir Giles (Pudsey)


Lawrence, Ivan
Shaw, Sir Michael (Scarb')


Lee, John (Pendle)
Shelton, William (Streatham)


Leigh, Edward (Gainsbor'gh)
Shephard, Mrs G. (Norfolk SW)


Lennox-Boyd, Hon Mark
Shepherd, Colin (Hereford)


Lilley, Peter
Shersby, Michael


Lloyd, Sir Ian (Havant)
Sims, Roger


Lloyd, Peter (Fareham)
Skeet, Sir Trevor


Lord, Michael
Smith, Sir Dudley (Warwick)


Luce, Rt Hon Richard
Smith, Tim (Beaconsfield)


Lyell, Sir Nicholas
Speed, Keith


Macfarlane, Sir Neil
Speller, Tony


MacKay, Andrew (E Berkshire)
Spicer, Sir Jim (Dorset W)


McLoughlin, Patrick
Spicer, Michael (S Worcs)


McNair-Wilson, M. (Newbury)
Steen, Anthony


McNair-Wilson, P. (New Forest)
Stern, Michael


Madel, David
Stewart, Allan (Eastwood)


Mans, Keith
Stradling Thomas, Sir John


Maples, John
Summerson, Hugo


Marland, Paul
Taylor, Ian (Esher)


Martin, David (Portsmouth S)
Thorne, Neil


Mates, Michael
Thurnham, Peter


Mawhinney, Dr Brian
Tracey, Richard


Maxwell-Hyslop, Robin
Trippier, David


Mayhew, Rt Hon Sir Patrick
Trotter, Neville


Miller, Hal
Twinn, Dr Ian


Mills, lain
Vaughan, Sir Gerard


Mitchell, Andrew (Gedling)
Waddington, Rt Hon David


Mitchell, David (Hants NW)
Waldegrave, Hon William


Moate, Roger
Walker, Bill (T'side North)


Monro, Sir Hector
Waller, Gary


Morris, M (N'hampton S)
Wells, Bowen


Moss, Malcolm
Wheeler, John


Neale, Gerrard
Widdecombe, Miss Ann


Nelson, Anthony
Wiggin, Jerry


Neubert, Michael
Wolfson, Mark


Newton, Rt Hon Tony



Nicholls, Patrick
Tellers for the Noes:


Nicholson, David (Taunton)
Mr. David Lightbown and


Nicholson, Miss E. (Devon W)
Mr. David Maclean.


Onslow, Rt Hon Cranley

Question accordingly negatived.

PETITIONS

Rating Reform (Scotland)

Mr. John Home Robertson: I am grateful for the opportunity to present a petition on behalf of my constituents against the Government's threat to impose a poll tax in Scotland. It is appropriate that I should have the opportunity to do so immediately after the Government have once again used their English majority to force through an instrument associated with that legislation.
The petition is signed by 457 residents of the neighbourhood of the royal burgh of Haddington which is the county town of East Lothian. They recognise that the crisis in the rating system has been caused by successive Government cuts in rate support grant and the gross unfairness of a poll tax that is likely to be set at £361 per head in East Lothian.
Under such a medieval taxation system, many people on modest means will have their local taxation burden doubled, while prosperous citizens will benefit spectacularly.
The poll tax legislation is unfair, undemocratic and unworkable. It is an insult to the nation of Scotland and I wholeheartedly support my constituents in Haddington in their petition to the House to repeal this vicious legislation.
To lie upon the Table.

Birmingham Children's Hospital

Mr. Jeff Rooker: I, with some anger and a good deal of bitterness, present a petition of 2,500 signatures from the patients, parents and friends of Birmingham children's hospital to draw to the attention of this honourable House the crisis in treatment —or lack of it—there.
My constituents know that those children have treatable conditions that are not being treated. They say to the House — they have been refused access to the Prime Minister—that we should do everything in our power, which we have not done so far, to support improvements in staff and equipment to make treatment available for those who need it at the time that they need it.
It was with some sadness and bitterness that parents came to the House yesterday and presented a petition of 40,000 signatures to 16 hon. Members who met them. They expect some answer from the House, and they wil not take silence from the Government or the House any longer.
To lie upon the Table.

Mr. Deputy Speaker (Mr. Harold Walker): Before I call the next hon. Member to present a petition, it may help hon. Members if I remind them of what our manual of procedure says about the presentation of petitions:
If a Member rises in his place to present a petition, he must confine himself to a statement of the persons from whom the petition comes, the number of signatures attached to it and the material allegations contained in it, and to reading the prayer of the petition.
I hope that hon. Members will bear that in mind.

Mr. Robin Corbett: In common with my hon. Friend the Member for Birmingham, Perry Barr (Mr. Rooker), I rise in sadness to present a petition from 2,500 people in Birmingham and the west midlands who are concerned about the lack of facilities at the Birmingham children's hospital that serves the regional needs of the people of the west midlands.
It must be a shame on all of us in the House that parents with children who need treatment at that hospital are denied it. The petitioners say that the Birmingham children's hospital has
insufficient resources to give the treatment required to treatable conditions in young patients from Birmingham and the West Midlands.
The petitioners pray that we will all do all in our power to
support improvement in staff and equipment so as to make treatment available to those who need it at the time they need it.
If the House does nothing else today, I hope that it will respond to this petition.
To lie upon the Table.

Mr. Dennis Turner: I rise to present a petition on behalf of 2,500 people who request that our honourable House should do everything in its power to support improvements in staff and equipment so as to make treatment available at Birmingham children's hospital for those who need it and at the time they need it.
To lie upon the Table.

Mr. Bruce Grocott: On behalf of 2,500 people from the west midlands, I rise to present a petition on behalf of Birmingham's children's hospital. Although the hospital is called Birmingham children's hospital, I must emphasise that people across the west midlands region are dependent upon the services provided by the hospital.
The petition includes signatories from all parts of my constituency of the Wrekin — people from Hadley, Oakengates, Ketley, Dawley, Madeley, Donnington and Wellington. It also includes people who were represented yesterday by a delegation which came to London, but which was unable to see the Prime Minister. Indeed, many of them had great difficulty in getting access to Downing street.
I present the petition on behalf of the people who are making a simple request, which can be met by the Government, to see that the funds are properly made available for children desperately needing treatment.
To lie upon the Table.

Mr. Peter Snape: I rise to present a petition on behalf of the 2,500 patients and friends of the Birmingham children's hospital.
That hospital provides a service both in Birmingham and to my constituency. The petitioners plead that hon. Members do everything in their power to ensure that patients of the hospital and others in the west midlands have the treatment that they need, when that treatment is needed, carried out by a surgeon who has been treating them at a hospital at which they have been treated and at a time that they feel that treatment is necessary.
The petitioners believe that that right should be extended to patients of the Birmingham children's hospital and to others in the west midlands. Surely it is the duty of hon. Members to represent the pleas of sick people either in our constituencies or in others.
To lie upon the Table.

Ms. Clare Short: I rise to present a petition on behalf of 2,500 people from throughout the west midlands who ask that the Birmingham children's hospital, which is in my constituency, but which serves children from throughout the region, should have sufficient resources to give treatment required for
treatable conditions in young patients from Birmingham and the West Midlands.
The hospital is loved and respected by people throughout the west midlands because of the quality of care that it provides for our children. What is going on at the hospital and the harm that is being done to children is an outrage and disgrace that makes people throughout the region, of all backgrounds and political persuasions, furious.
The view in Birmingham is that the package that has recently been put together by the regional health authority to pretend to deal with the problem is too late and is inadequate. People are not satisfied that children should be sent to other hospitals or sent to the private sector. We want resources for our hospital, so that our children can be treated by the doctors who know them and in the hospital that they love.
To lie upon the Table.

Mr. David Winnick: I rise on behalf of those in the west midlands who believe that it is quite wrong for children such as Matthew Collier to have to wait a long time for the urgent operations that they require. They believe that it is right and proper that there should be far less delay. It is appropriate that this petition should be presented following today's debate on the National Health Service and my Adjournment debate last Friday on the difficulties created by the fact that there are insufficient nurses in the intensive care unit at Birmingham children's hospital.
The parents and children who came to London to see the Prime Minister yesterday—but whom she would not see—should know that we shall continue to raise this matter and the problems of the hospital at every opportunity—

Mr. Deputy Speaker: Order. I hope that the hon. Gentleman will bear in mind what I said to the House earlier.

Mr. Winnick: We shall raise the matter at every opportunity—through debates, questions and petitions—until the children's hospital in Birmingham has sufficient resources to prevent delays such as the delay that Matthew Collier had to endure.
To lie upon the Table.

Mr. Anthony Beaumont-Dark: It is not without significance for me that 50 years ago next month the Birmingham children's hospital saved my life. It is good, if sad, to be able to present a petition on behalf of Birmingham children's hospital and all those who go to it, as I did, for treatment. The petition says that the hospital has insufficient resources to give the treatment that I had then, which remains necessary to this day. I hope that it will be noted in the circles that matter most in Government that I am proud to argue that those resources should be made available so that people may be cured.
To lie upon the Table.

Mr. Dave Nellist: The House is already aware of the case of my constituent, seven-year-old Adrian Woolford, who has been repeatedly denied heart operations at the Birmingham children's hospital. I am having to present this petition, carrying the signatures of 2,500 citizens of the west midlands, because the Prime Minister refused to meet children and parents and accept it from them herself yesterday. It is about the 90 Adrians in our region who have been denied life-saving operations because of under-funding in the National Health Service.
The petition says:
the Birmingham Children's Hospital has insufficient resources to give the treatment required to treatable conditions in young patients from Birmingham and the West Midlands. Your petitioners pray that your … House will do everything in its power to support improvement in staff and equipment so as to make treatment available to those who need it at the time they need it.
It is with anger, weeks after the announcement that £38 million had been spent on the refurbishment of the DHSS headquarters in Whitehall, with its walk-in jacuzzis and crystal chandeliers, that I note that the Birmingham children's hospital has still been given insufficient funds. We need that money for the hospitals that serve our people.
To lie upon the Table.

Mr. John Hughes: I rise to present a petition on behalf of 2,500 patients, parents and friends of the Birmingham children's hospital. Unlike the childhood of the petitioners' children, mine was blessed with good health. Like every child, I read my fairy tales. I can recall only one woman as cold as the Prime Minister, who treats lightly the chronic condition of Matthew Mulhall while selfishly demanding instant surgery for her minor complaint. That woman was Hans Andersen's snow queen, whose domain was melted by the warmth of a child's tear. I desperately pray that the warmth of the petitioners' children's innocent tears will have the same effect on the domain of the Commons snow queen.
To lie upon the Table.

Mr. Roy Hattersley: I rise to present a humble petition on behalf of 2,500 patients parents and friends of Birmingham children's hospital, calling on this honourable House to take note of the gross inadequacy of resources available to the hospital. It calls on the House to do all in its power to provide sufficient resources to end the suffering and the anguish that the shortage of resources is now causing.
The petitioners are aware of the devoted service that is being rendered to the children of the entire region by the staff who are employed in the Birmingham children's hospital, but they are equally conscious that the hospital is desperately under-staffed and that the nurses, doctors, ancillary staff and all the others who are employed there are unable to meet the demands on their time. The petitioners are particularly conscious of the position in the intensive care unit where there are spaces where there should be beds, and beds vacant that should be occupied by children receiving necessary surgery.
We offer this humble petition in the hope that pressure can be brought on the Government to bring what is no more than justice to those suffering children and to end a desperate need.
To lie upon the Table.

Mrs. Llin Golding: I rise to present to the House a petition on behalf of 2,500 patients,

parents and friends of Birmingham children's hospital. I wish to bring a simple plea to the House — that the death of baby Barber, who lived in my constituency, should not have been in vain.
To lie upon the Table.

Ms. Joan Walley: I rise on behalf of 2,500 constituents in the west midlands, many of them from north Staffordshire, who pray that this House will recognise the need to provide proper resources for the Birmingham children's hospital.
I gave my pledge to the parents of Claire Wise that I would do everything in my power, as would any parent, to make sure that those operations and treatments could be available when needed. Therefore, I pray that we shall do everything in our power to support improvement in staff and equipment to make treatment available to those who need it at the time they need it.
To lie upon the Table.

Mr. Jack Ashley: I beg to support the petition with one signed by 2,500 people. The petition is both a plea and a condemnation. It is a plea for more money for the Birmingham heart hospital for children. It is a plea for cash for that hospital to provide resources, facilities and treatment. It is a condemnation of the Government for failing to provide that.
The petition is staggering in so far as in 1988 we have to plead for life-saving treatment for children. I therefore offer the petition because those children are in urgent need of treatment.
To lie upon the Table.

Mr. Mark Fisher: I rise to present a petition on behalf of 2,500 parents, patients and friends of the Birmingham children's hospital, many from Stoke-on-Trent and north Staffordshire, who are appalled by the insufficient resources at that hospital and the inability of the hospital to respond to the needs of those children, especially in the cardiac surgery and intensive care units. Although the hospital has sufficient surgeons and theatre time, it is unable to treat the children who could be treated in the way that they need because of lack of room in the intensive care unit.
The petitioners, my constituents, cannot understand how children like Michelle Knight of Bentilee and Jane Ball, who is still waiting for heart surgery after weeks and weeks in Abbey Hulton, cannot be treated. The people of Stoke-on-Trent are amazed that the Government cannot and will not respond to the pleas of those parents, patients and friends of the hospital.
To lie upon the Table.

Mr. Terry Davis: I too wish to present a petition from 2,500 parents and friends of Birmingham children's hospital. The signatories include several people who live in my constituency, and in other parts of the city of Birmingham. It also includes people who live in other metropolitan districts in the west midlands, and in an area stretching from Telford to Coventry.
As a father whose daughter's life was saved by an operation at the age of four, I understand and share the feelings of my constituents and the other signatories of the petition. I commend it to the House, on the very evening on which I am told that the Central Birmingham health authority has decided to consider closure of Birmingham


general hospital, and of the medical school at Queen Elizabeth hospital—proposals which, if put into effect, will only exacerbate the problems at the Birmingham children's hospital.
To lie upon the Table.

Young Domestic Workers

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Peter Lloyd.]

Mr. Peter Hardy: Young people are still taught at school that slavery was abolished within the British empire a century and a half or more ago. That major step was largely credited to the efforts of one of Yorkshire's most celebrated Members, William Wilberforce, who represented our county between 1784 and 1812.
Unfortunately, there are still parts of the world where slavery is practised, and it is saddening that some developments in our own country seem little removed from those inhumanities of the past. The experience of my constituent Miss Ellen O'Neil, of Thrybergh, near Rotherham, should be seen as an example of a grossly unsatisfactory position and as a warning that fully justifies this debate.
Like the majority of our young people, Miss O'Neil sees little prospect of suitable or normal employment at home, for our economic position is very grave. Vigorous activity and keen determination are displayed in persistent efforts to create jobs, but each step forward seems to be followed by rearward strides.
It is sad that, in our schools, young people receive decent education but see little opportunity. That is the case at Thrybergh school, which Ellen attended. But, in another of my constituency schools—a good school, Swinton—just 8 per cent. of last year's leavers secured normal work last year. Since then we have seen an announcement that Kilnhurst colliery has come to the end of the road. Last Friday I received the news that Canning Town Glass, in my constituency, is to close in April. That closure will cost nearly 480 jobs. The point is made to establish the context of Ellen's experience, but it also illustrates quite unreasonable conduct on the part not only of the domestic employer, but of a substantial British company.
The Canning Town Glass closure has been announced despite full assurances given to me on behalf of Guinness at the time of the takeover in 1985, and expressed in two letters by the then chief executive. Because of those assurances, I did not seek to join the campaign to refer the matter to the Monopolies and Mergers Commission. Had I known then what I know now—that the assurances were worthless—I, and perhaps my hon. Friends, would have joined in that demand.
I am glad that my hon. Friends the Members for Don Valley (Mr. Redmond) and for Rother Valley (Mr. Barron) are here. One of my hon. Friends accompanied me on a visit to the Under-Secretary of State for Industry this morning. I hope that the Government will insist that honourable conduct is required; otherwise, we shall be demonstrating that, in relation to the direction of our commerce and industry, an Englishman's word is no longer his bond. That lack of reliability and the grounds for distrust are particularly shocking where younger people are concerned. Miss O'Neil's case illustrates the position dreadfully.
My constituent wished, and still wishes, to work with children. Some time before her experience Miss O'Neil studied at Rockingham college of further education in Wath-upon-Dearne where I live. It is a reputable establishment which seeks to serve local communities with


considered relevance and to meet the developing needs. A course, sometimes called a nanny course, is run effectively at the college. A number of young ladies have been equipped to work as nannies, and I believe that many of them have had satisfactory experiences. The course is a proper one, although I do not care for the implications for my area. I accept that the girls have had relevant training and that some of them have secured work which is not available in the locality.
Ellen saw an advertisement in the local newspaper, the Rotherham and South Yorkshire Advertiser. It sought a mother's help to care for a family with three children in Surrey. Ellen applied and was appointed, commencing work on 16 January last year. She was to live in and work from 7.30 in the morning until the parents, her employers, returned home from their work or from their dinner engagements. Ellen stayed just under six weeks and she tells me that the parents stayed at home only about five evenings. That meant that my constituent bore substantial responsibility for long hours from early in the morning usually until very late in the evening. The three children were 6, 9 and 14 years of age. I gather they attended primary day schools, returning home at 3.30 and 4.30 pm.
Ellen was due to be paid £25 per week for those long hours. During the first week her employers borrowed £13·79 from her. Despite Ellen's requests, that debt was not repaid. although her employers were always just about to do so. At first Ellen was to be paid monthly. Then her employers said that they would pay her weekly. She received £25 on 30 January. There was no wage slip or wage packet; perhaps that point could be considered by the Minister.
During her period of work Ellen had just one day and one weekend off, during which she returned home. After further absence of payment and further lack of repayment of debt, she returned home on 24 February. Ellen tells me that she is owed £105·45. Her employers said that they would send the sum on by post. They did not. In March Ellen telephoned her former employers to ask about the money due and was told that it was in the post. Ellen did not receive it.
Ellen consulted a local solicitor who acted properly. The case was heard in Reigate court and was successful. However, on 14 October Ellen was told, almost incredibly, given her experience, that her former employers possessed nothing of sufficient value to cover the costs of removal and sale. So Ellen has not received any of the outstanding sum.
Ellen returned to Thrybergh. Not surprisingly, she has not been able to find another job, so she became dependent upon state benefits, like thousands of my constituents. This is a major point to which I hope the Minister will attend; under the rules, she was assumed voluntarily to have surrendered her employment, so benefit was suspended for six weeks.
Ellen did not come to see me immediately. Perhaps she hoped that the court would secure justice for her. Perhaps she felt that her former employers would act honourably. She exercised a gentle patience, for she has not an aggressive or unpleasant personality. After I had heard Ellen's story in November, I wrote to her former employers. There was no reply. I heard other similar stories and felt that I should seek a debate. I wrote to the employers again on 29 December. There has been no reply to either letter.
There has been not a word in response, not a word of explanation, not a word of regret for outrageous treatment. The people may have difficulties; I do not know. They could have said so, but they did not. I must assume that they have acted in a disreputable and scandalous manner. They did not respond to the normal official inquiry made after Ellen had left. They could have done; that would have eased the difficulties she experienced.
That leads to another major point. We ought not to structure our social arrangements so that penalties are placed upon an employee who can no longer tolerate utterly unreasonable conduct from an employer, who in this case cannot even be bothered to respond to official questions.
Ellen was told that the outstanding sum and her P45 tax form would be sent to her. They were not. What action is taken against negligent employers who may cause difficulty to their employees by failing to provide necessary information to official sources? The Minister should consider that.
We have a good careers office in our area, which makes the best of an astonishing and difficult task. I have corresponded with the principal officer, Mr. Pappini who is an able and most experienced official. He confirms that when a local domestic position is notified it is checked by his service. However, increasingly these jobs are not offered through the careers service or even through the more reputable agencies. The result of private operation is, I fear, that we may have far more serious cases to come.
The careers service takes the view that these young people are vulnerable and that the paucity of legislation creates a need for information and guidance. Obviously, our local careers service can help in South Yorkshire, but it is largely powerless in the southern counties.
I understand that the Government are keen to see our young people entering the service sector, especially domestic service. This situation was a frequent experience in the days portrayed in the television series "Upstairs, Downstairs". However, if this change develops, the Minister should accept that not all such employers are likely to be honourable, as Ellen's case demonstrates. Perhaps the recipient areas should provide a positive careers service to assist incoming young workers.
I have always viewed the privileges of Parliament as an essential right that should be exercised after deliberation. To use privilege lightly is wrong. However, I believe that I am wholly right to use it now. Ellen's employers, who borrowed from her but did not repay, and who employed her but did not provide her with the salary that they promised, ought to be the subject of the exercise of that right. Ellen's employers agreed to pay her £25 a week. They paid her that sum once, and no more. Ellen's employers were seeking domestic service at a dreadfully low wage, given the long hours that she was required to work. It seems that they required her to be on duty while they were at work, and in the evenings, which they, too, enjoyed.
Clearly, Ellen worked for very long hours, probably for much longer than her employers. I suspect that their incomes were very much higher than Ellen could ever dream of securing. Her employers failed to discharge their responsibilities. I do not yet know whether they paid the employer's national insurance contributions. I understand that two other local girls, who returned from a similar experience, found that their employers had failed to pay


those contributions. I shall be interested to learn, in due course, whether the contributions have been paid in Ellen's case, and what action will be taken if there has been any employer's negligence.
Does the Minister consider that such negligence should apparently pass without remark or penalty? Ellen's employers were due to pay her £25 a week; they paid her once, and they owe her more. I do not know how much they were paid while they failed to pay her. Her employers were Mr. and Mrs. Atkinson of Field road, Charlwood, Surrey. They have not replied to my letters, although Ellen tells me that Mr. Atkinson is a professional surveyor. I wonder whether that profession really considers £25 to be reasonable payment for a very long week, or whether the relevant professional body has grounds for pride in its member.
I am told that Mrs. Atkinson was employed by Dan-Air, a reputable airline. I wonder whether that or any other reputable airline would regard £25 a week as reasonable pay. Perhaps it should consider that one of its employees obviously considers £25 a week to be a reasonable, fair wage. Of course, wages in Surrey are more than £60 a week higher than they are in South Yorkshire, so presumably the employers thought that they were doing Ellen a favour.
Wentworth is now grievously hurt by economic change, which may be rather welcome in Charlwood, Surrey. Perhaps people there have become so materialistic that they even feel pride and approval that among their number are people who behave as these employers did. I do not know. But once upon a time people, even in such areas, subscribed to the view that we were one nation. We may have been; we are not now. The economic condition of South Yorkshire and Ellen O'Neil's experience demonstrate that.
In this case and in others, the Government and society seem eager and swift to punish or penalise our young people, who give up work, even when they have good reasons for doing so, as Ellen's case reveals.
Am I not entitled to ask the Government to provide a rather better balance in our social arrangements and to respond much more effectively to negligent or disreputable employers? There have been substantial changes in industrial relations law since 1980. More obligation is being placed upon workers and their organisations. Such cases as Ellen's show that there is now an obvious need for action in regard to the defaulting and irresponsible employer. Ellen did not receive her pay. Other girls were not credited with appropriate insurance contributions. There had been no contract of employment, no readily available advice, no wage packet, no proper documentation. Yet, when she gave up her job, there was immediate application of penalty.
I know that good organisations such as our careers service, and good establishments such as the Rockingham college, advise young people to secure an employment contract. But young people desperate for work, operating in isolated conditions, may not feel able to insist upon that provision. Perhaps the Government should do so on their behalf.
Ellen and others of her generation may already have had to tolerate far too much. But it seems that society is determined that they should continue to do so. I find this insistence deplorable, especially when it seems that some of the yuppies and people like them in our community are

prepared to allow regional imbalance to reach the outrageous levels which we now face. These levels place an intolerable burden not least upon our young people, and I must ask the Minister whether he would now agree that one is justified in suggesting that Britain has reached such a pass that justice and morality must now be left to the mercy of market forces, as they appear to have been in Ellen's case.

The Parliamentary Under-Secretary of State for Employment (Mr. John Lee): I should like to begin by commending the hon. Member for Wentworth (Mr. Hardy) quite genuinely on his success in getting this issue raised on the Adjournment. The case of his constituent, Miss O'Neil, which has prompted him to raise the general issue of young domestic workers, is indeed a sorry and distressing one. On the facts presented, Miss O'Neil's ex-employers have behaved in a disgraceful and totally unacceptable fashion. But I do not believe that their behaviour is typical of the majority of employers who take on nannies or mothers' helps. In most cases such employers behave honourably towards their employees and many go so far as to treat them as part of the family. But, sadly, there is a small minority of bad employers, and Miss O'Neil had the misfortune to come up against just such a one.
Before I go into the detail of Miss O'Neil's case, I should like to say a few words about the Government's general approach to contract of employment issues. It is a well-established principle that terms and conditions of employment, including rates of pay and hours of work, are, in general, matters for agreement between the employer and the employee concerned, or their representatives. This enables them to agree the terms of a contract of employment to suit the job in question and their particular circumstances and preferences. It would be neither right nor practicable for the Government to intervene in this area. This flexibility gives the potential employee a chance to consider, for example, whether the hours he or she is going to have to work and the pay are acceptable.
A contract of employment does not have to be written down: by starting work the employee accepts the terms and conditions offered and there is an implied contract. But within 13 weeks of starting work an employee is entitled by law to be given a written statement of his or her terms and conditions of work by his or her employer. If the employer fails to provide such a written statement, the employee concerned may apply to have the complaint heard by an industrial tribunal.
In addition, most employees are entitled to be given an itemised pay statement by their employer at or before the time of payment. This has to include details of the gross amount paid and a note of the deductions which have been made. Again, failure by the employer to provide such a statement may result in a case before an industrial tribunal.
The main employment protection measure is, of course, the right not to be unfairly dismissed, and, again, those to whom this right applies may take their case to an industrial tribunal. There is a qualifying period of continuous employment for this right: those who work more than 16 hours per week qualify after two years' continuous employment; and for those who work less than 16 hours per week but more than eight the qualifying period is five


years. A qualifying period is necessary to give employers a chance to test whether the person concerned is right for the job and to demonstrate the employee's commitment to the employer. Without such a qualifying period, employers would be reluctant to take on new staff because of the possibility of having to defend an unnecessary tribunal case.
An employee who believes that he is being treated so badly by his employer as to amount to a fundamental breach of contract, and providing he has the appropriate qualifying service, may resign and claim constructive unfair dismissal before a tribunal.
The argument that there is insufficient employment protection is regularly advanced by Opposition Members, but we regularly receive correspondence from employers and others complaining that there is so much employment protection regulation that it puts them off recruiting new employees. Indeed, that complaint has been substantiated by evidence from a number of research projects, and we have some sympathy with it.
Our strategy of deregulation is designed to create the conditions in which enterprise and initiative may flourish and to reduce red tape wherever possible and where it makes sense to do so. That does not mean that we intend to sweep away all employment protection measures; far from it. But we are concerned that we should strike the right balance between the need to protect employees from the most unscrupulous employers and the need to avoid excessive burdens on employers. This will encourage the creation of more jobs and help to tackle the problem of high unemployment to which the hon. Gentleman referred. The consistent fall in the level of unemployment in recent months is evidence of the success of the Government's policy in this area.
Some might suggest that a contribution to the improvement of the terms and conditions of those employed as nannies or mothers' helps would be the introduction of a statutory national minimum wage. However, the Government's view is that such a move would not help the position of domestic workers or the low paid generally.
There are a number of reasons for that. First, it would directly raise the wages of those below the statutory minimum without any change in output. This would not only add to employers' costs and reduce competitiveness, but lead to a loss of jobs, as the rate of pay fixed might be more than some employers could afford. My officials estimate that a national minimum wage of £80 a week could result in job losses ranging between 60,000 and 600,000 over a period of time.
In addition, all experience shows that pay differentials cannot be artificially compressed. As soon as the wages of the low paid are raised, attempts are made by workers with higher rates of pay to press for similar increases to maintain pay differentials, leaving the less well off in the same relative position as before. The pressure to restore differentials would itself add to general wage costs and erode competitiveness. We see no signs that the higher-paid workers are prepared to hold back their claims to help the low paid.
Moreover, a national minimum wage would be inconsistent with our firmly held view that pay is a matter for determination by employers and employees or their representatives. They are in the best position to decide

what enterprises can afford or need to recruit and retain staff with the right skills and experience. The Government do not intervene.
The specific case of Miss O'Neil has already been the subject of correspondence between the hon. Gentleman and my hon. Friend the Under-Secretary of State, the Member for Teignbridge (Mr. Nicholls).
I have already explained at some length that contracts of employment are matters for negotiation and agreement between the parties concerned and that it is inappropriate for the Government to interfere. It follows from that that, should either party decide subsequently that they are unhappy with the terms of the contract as agreed, it is up to them to take the necessary action to terminate that contract.
That, I believe, is precisely what Miss O'Neil did. Moreover, when, as it turned out, her former employer did not pay her the wages which were due to her, she very properly took a case in the small claims section of the county court. I must congratulate Miss O'Neil on her determination in sorting out her predicament. I suspect that many other people in a similar situation would have given up at that point. But she continued to defend her rights and obtained a county court judgment against her former employer. That covered not only wages due to her which had not been paid, but money borrowed from her by her employer and not repaid, as well as the expenses she incurred in travelling from her home in the north of England to Reigate to attend the court hearing.
I should say a word here about the unfortunate fact that, although she has obtained a county court judgment against her former employer, Miss O'Neil has been unable so far to recover what is owed to her. I am sure all Members of this House will sympathise with the position in which Miss O'Neil finds herself. She may wish to bear in mind that in addition to a warrant of execution, which she has already tried, there are other means of enforcement open to her. If she approaches the court in which she obtained the judgment, she will be able to obtain a booklet, produced by the Lord Chancellor's Department, entitled "Enforcing Money Judgments in the County Court", which gives details of various alternative methods of enforcement. At the risk of stating the obvious, perhaps I should add that no method of enforcement can guarantee payment of a debt from a debtor who does not have the means to pay.
I come now to the unemployment benefit position of Miss O'Neil. Unemployment benefit is, of course, intended for those people who become unemployed through no fault of their own and remain so throughout the period of their claim. It is a long-established principle therefore that a person who leaves his employment voluntarily without just cause, or loses his job because of misconduct, may lose his entitlement to benefit, currently for up to 13 weeks.
The question whether a person had just cause for leaving his job voluntarily is a matter for the independent adjudicating authorities to consider in the light of case law over the years. The independent adjudicating authorities specially appointed for this purpose under the Social Security Act 1975 are the adjudication officer in the first instance; on appeal, the social security appeal tribunal; and there is a further right of appeal, in certain circumstances, to the social security commissioner.
I understand that Miss O'Neil first claimed unemployment benefit at the beginning of March last year. Entitlement to unemployment benefit depends, of course,


on the satisfaction of two contribution conditions. The first is that class 1 national insurance contributions must have been paid on earnings of at least 25 times the weekly lower earnings limit — currently £39 — in any one tax year since 6 April 1975.
The second condition is that class 1 national insurance contributions must have been paid or credited on earnings of at least 50 times the weekly lower earnings limit in the last complete income tax year before the benefit year in which the spell of unemployment begins. The benefit year starts on the first Sunday in January and ends on the first Saturday of the following year. Claims made during 1987 are therefore based on contributions paid during the 1985–86 income tax year. Since Miss O'Neil's employment in Reigate was her first employment, she had not paid sufficient contributions to become entitled to unemployment benefit. I understand, however, that she has been receiving supplementary benefit since the end of March last year.
I have already explained the circumstances in which unemployment benefit may be suspended. When a doubt arises on a person's claim for unemployment benefit, the Department is obliged to seek confirmation from the employer of the reason why the employment ended. In cases in which the employer fails, after reminders, to respond to inquiries about the reasons why the claimant left his employ, consideration is given to lifting the suspension. In such a case, when the suspension is lifted, payment would be made from the date of claim.
I understand that in Miss O'Neil's case her employer failed to return the form sent to establish the circumstances in which her employment had ended. As a result, disqualification of unemployment benefit or contribution credits because she had voluntarily left her employment or had lost it because of misconduct was not considered.
Although I am not aware that in Miss O'Neil's case there was a failure on the part of the employer to pay national insurance contributions, the hon. Gentleman has suggested that that has arisen in other cases that he knows about. I understand from the DHSS, which is, of course, responsible in this area, that it has seen little evidence of

any national problem in relation to nannies. It is the view of the Inland Revenue that nannies are in class 1 employment. An individual who has a complaint about this should go to his or her local social security office, which will of course investigate the complaint.
Finally, I should like to refer to the wider issue underlying the matters that we have been discussing tonight—unemployment. Despite the encouraging signs in recent months, it remains a serious problem and the Government are making a significant contribution to overcoming the problem by fostering an environment in which enterprise and initiative may flourish. That leads to the creation of new jobs, by helping those unfortunate enough to be unemployed to relearn the skills of work by a spell on a training course or a scheme specifically designed to help the unemployed back to work.
I am particularly pleased to see that in Wentworth there has been a decrease of almost 13 per cent. in the total numbers of unemployed in the 12 months to December 1987. It is therefore all the more sad and disheartening to hear of the impending closure of Canning Town Glass, to which the hon. Gentleman referred. I should like to emphasise that the full facilities of the Department and of the Manpower Services Commission are available to help redundant people to find new jobs, retrain or set up in businesses of their own, and those facilities will be brought to the attention of those involved.
In concluding, perhaps I might return to where we started and the particular case of Miss O'Neil. Can anything be done to prevent that sort of thing happening again? However much we legislate, we are never going to be able to eradicate the sort of behaviour that Miss O'Neil had the misfortune to experience. There are a few unscrupulous employers in this country, and that is an unfortunate fact of life. Individuals do not need to put up with unfavourable working conditions, and before committing themselves to a particular job, it is up to them to be satisfied that the conditions on offer are acceptable. When it is only after starting the job that the employee realises that it is not suitable, then, as I have explained, remedies are available.
Question put and agreed to.
Adjourned accordingly at twenty-nine minutes past Twelve o'clock.